1
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Bekkers S, Stewart L, Panizza BJ. Time is function and survival. ANZ J Surg 2023; 93:2281-2282. [PMID: 37849061 DOI: 10.1111/ans.18680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/19/2023]
Affiliation(s)
- Stijn Bekkers
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Otolaryngology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Linda Stewart
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Benedict J Panizza
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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van Keulen S, Szweryn WJ, Jansen TT, Bekkers S, Kunst HP. Sensorineural Hearing Impairment Recovery after Transmastoidal Surgery for a Petrous Apex Cholesterol Granuloma: A Case Report. J Int Adv Otol 2022; 18:447-450. [PMID: 35971269 PMCID: PMC9524395 DOI: 10.5152/iao.2022.21349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Stan van Keulen
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Walter J. Szweryn
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, The Netherlands
- Corresponding author: Walter J. Szweryn, e-mail:
| | - Thijs T.G. Jansen
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, The Netherlands
| | - Stijn Bekkers
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, The Netherlands
| | - Henricus P.M. Kunst
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, The Netherlands
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3
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Robijn S, van Keulen S, Verhage-Damen G, Bekkers S. An Adolescent With a Retropharyngeal Swelling: To Drain or Not to Drain? Chest 2022; 162:e89-e92. [PMID: 35940669 PMCID: PMC9353107 DOI: 10.1016/j.chest.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/31/2022] [Accepted: 03/02/2022] [Indexed: 11/20/2022] Open
Abstract
An 18-year-old patient with a history of COVID-19 (1 month previously) was admitted with malaise and complaints of a stiff neck, a left-sided cervical mass, headache, and difficulty in swallowing and breathing, which had been present for 4 days. Two days after the onset of the first symptoms, a painless skin rash on the legs, arms, palms of both hands, and soles of both feet developed. Despite 2 days of treatment with antibiotics (amoxicillin/clavulanic acid, 500/125 mg three times daily orally), symptoms progressed. On presentation, the patient was alert and oriented, there were no neurologic disorders, and all symptoms related to the recent COVID-19 infection had subsided. His medical history was negative for sexually transmitted diseases, and the patient had received all vaccines except for meningococcus and COVID-19.
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Thevis M, Leow TYS, Bekkers S, Otten J, Waterval JJ, Derks J, Buil JB, Kunst DPM, Jansen TTG. Diagnosis, treatment and prognosis of otomastoiditis induced by Fusobacterium necrophorum: A retrospective multicentre cohort study. Anaerobe 2022; 76:102587. [PMID: 35595214 DOI: 10.1016/j.anaerobe.2022.102587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Otomastoiditis caused by the anaerobic Fusobacterium necrophorum (F. necrophorum) often induces severe complications, such as meningitis and sinus thrombosis. Early diagnosis is difficult, partly because little is known about specific early signs. Comprehensive research about clinically chosen antimicrobial therapy has not been done yet and prognostic information about otomastoiditis caused by F. necrophorum is scarce. More knowledge about this subject is required. METHODS In this retrospective cohort study, we included all cases of otomastoiditis caused by F. necrophorum treated in two university medical centres in the Netherlands during the past 10 years. Data was gathered from patient records and analysed using independent sample T-tests and Chi2-tests. RESULTS This study reveals that otomastoiditis caused by F. necrophorum potentially induces neurological sequelae. Thereby, 80% of all included patients (n = 16) needed readmission within six months due to recurrence or complications of otomastoiditis caused by F. necrophorum. Mean (range) of age, CRP and temperature were 4.5 years (0.9-29.3), 243 mg/L (113-423) and 40 °C (37-41). All patients were hospitalized and treated with antibiotics, mostly metronidazole (n = 13/16) and a β -lactam (n = 15/16). Additional treatment contained low molecular weight heparin (83%, n = 10/12), dexamethasone (78%, n = 7/9) and/or surgery (80%, n = 12/16, whereof 9/12 mastoidectomy). CONCLUSIONS Patients and/or their parents need to be informed about this potential unfortunate prognosis when otomastoiditis caused by F. necrophorum is diagnosed. To improve early diagnosis, otomastoiditis caused by F. necrophorum should be suspected and therefore immediately cultured when a) young children present with otomastoiditis, with b) high CRP values, and/or c) vomiting and decreased consciousness.
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Affiliation(s)
- Madelon Thevis
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - Theresa Y S Leow
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - Stijn Bekkers
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - Josje Otten
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands.
| | - Jerome J Waterval
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands.
| | - Jolanda Derks
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - Jochem B Buil
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Dirk P M Kunst
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands.
| | - Thijs T G Jansen
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
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Leow TYS, Bekkers S, Janssen AM, Pegge SAH, Kunst HPM, Waterval JJ, Jansen TTG, Henriet SSV, van Aerde KJ, van Ingen J, Hol MKS. Quality of life in children receiving treatment for Mycobacterium abscessus otomastoiditis. Clin Otolaryngol 2022; 47:529-535. [PMID: 35340110 PMCID: PMC9314591 DOI: 10.1111/coa.13931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/31/2022] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Theresa Y S Leow
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stijn Bekkers
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arno M Janssen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sjoert A H Pegge
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Henricus P M Kunst
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.,Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen, The Netherlands
| | - Jerome J Waterval
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen, The Netherlands
| | - Thijs T G Jansen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefanie S V Henriet
- Department of Pediatric Infectious Disease and Immunology, Amalia's Children Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Koen J van Aerde
- Department of Pediatric Infectious Disease and Immunology, Amalia's Children Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jakko van Ingen
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Myrthe K S Hol
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Groningen, Groningen, the Netherlands.,Research School of Behavioral and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, Netherlands
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6
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Bekkers S, de Bock S, van Hulst K, Kok SE, Scheffer ART, van den Hoogen FJA. The medium to long-term effects of two-duct ligation for excessive drooling in neurodisabilities, a cross-sectional study. Int J Pediatr Otorhinolaryngol 2021; 150:110894. [PMID: 34474251 DOI: 10.1016/j.ijporl.2021.110894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/31/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aims to evaluate the medium to long-term (1-12 years) effectiveness of two-duct ligation (2-DL) in patients with nonprogressive neurodisabilities. METHODS Main outcomes included a Visual Analogue Scale (VAS), Drooling Severity (DS) and Drooling Frequency (DF), collected at baseline, 32 weeks postintervention and 1-12 years postintervention. Secondary outcomes were adverse events (AEs), and satisfaction. RESULTS Forty-two patients were analyzed (mean age 17 years, mean baseline VAS 82). VAS decreased significantly from baseline to long-term (n = 30. Mean difference -36.5, CI -47.0 to -26.0, p ≤ 0.001; -26.1, CI -36.2 to -15.9, p ≤ 0.001). However, long-term VAS significantly increased compared to VAS at 32 weeks (+10.4, CI 1.0-19.8, p = 0.031). Out of 42 patients, 64% would recommend 2-DL to peers. CONCLUSION There is a significant subjective 2-DL effect on drooling severity in the medium to long-term as reported by patients and caregivers, but there is also a certain degree of recurrence in this time span, and 33% of the patients required subsequent treatment. However, the majority of patients and/or caregivers would recommend 2-DL to peers.
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Affiliation(s)
- Stijn Bekkers
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Sanne de Bock
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Karen van Hulst
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Saskia E Kok
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arthur R T Scheffer
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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7
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Bekkers S, Pruijn IMJ, van der Burg JJW, van Hulst K, Kok SE, Delsing CP, Scheffer ART, van den Hoogen FJA. Surgery versus botulinum neurotoxin A to reduce drooling and improve daily life for children with neurodevelopmental disabilities: a randomized controlled trial. Dev Med Child Neurol 2021; 63:1351-1359. [PMID: 33997959 PMCID: PMC8597158 DOI: 10.1111/dmcn.14924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/28/2022]
Abstract
AIM To compare the effect of bilateral submandibular duct ligation and botulinum neurotoxin A (BoNT-A) on drooling severity and its impact on daily life and care in children and adolescents with moderate-to-severe drooling. METHOD This was a randomized, interventional, controlled trial in which 53 children and adolescents (31 males, 22 females, mean age 11y, range 8-22y, SD 2y 10mo) with cerebral palsy (58.5%) or other non-progressive developmental disorders (41.5%) were randomized to BoNT-A (n=26) or bilateral submandibular duct ligation (n=27). A parent questionnaire on the severity of drooling in specific positions and daily activities and the impact of drooling on daily life and care was filled out at baseline and 8 and 32 weeks posttreatment. RESULTS Both BoNT-A and bilateral submandibular duct ligation had a positive effect on daily care, damage to electronic equipment and/or furniture, social interactions, and self-esteem. However, bilateral submandibular duct ligation had a significant greater and longer-lasting short- (8wks) and medium-term (32wks) effect on daily care, reducing damage to electronic devices, and improving social interactions and satisfaction with life in general. INTERPRETATION This randomized controlled trial confirms reduced drooling by both BoNT-A and bilateral submandibular duct ligation, but provides new evidence on improved well-being through a reduction in drooling. Even though there is a greater risk of complications and morbidity after bilateral submandibular duct ligation, compared to BoNT-A there was a significantly greater and longer-lasting positive effect on most outcomes. What this paper adds Bilateral botulinum neurotoxin A (BoNT-A) and submandibular duct ligation had a positive effect on the well-being of individuals with moderate-to-severe drooling. Bilateral submandibular duct ligation had a greater effect on the impact of drooling during daily care than BoNT-A. Bilateral submandibular duct ligation reduced damage to electronic devices and improved social interactions and satisfaction with life.
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Affiliation(s)
- Stijn Bekkers
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Ineke M J Pruijn
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Jan J W van der Burg
- Department of Pediatric RehabilitationSint MaartenskliniekNijmegenthe Netherlands,School of Pedagogical and Educational ScienceRadboud UniversityNijmegenthe Netherlands
| | - Karen van Hulst
- Department of RehabilitationRadboud University Medical CenterDonders Institute for Brain, Cognition and BehaviourNijmegenthe Netherlands
| | - Saskia E Kok
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Corinne P Delsing
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Arthur R T Scheffer
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
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Sambola A, Lozano Torres J, Olmos C, Ternacle J, Calvo-Iglesias FE, Tribouilloy C, Reskovic Luksic V, Separovic-Hanzevacki J, Park SW, Bekkers S, Chan KL, Arregle F, Lung B, Lancellotti P, Habib G. Predictors of mortality in patients with left-side infective endocarditis, the ESC-EORP EURO-ENDO registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Infective endocarditis (IE) is associated with high in-hospital mortality, ranging from 16% to 25%, despite improvement in diagnostic and therapeutic strategies, mainly due to complications and heterogeneity of the disease. Baseline risk stratification is essential, in order to focus an aggressive management toward high-risk patients.
Purpose
We sought to assess the association between surgery and 30-day mortality rate as related to vegetation size.
Methods
The ESC-EORP EURO-ENDO registry is a prospective multicentre observational study of patients presenting with definite or possible IE in Europe and ESC-affiliated/non-affiliated countries. Patients were included from January 2016 to 31 March 2018 in 156 centers from 40 countries. Clinical data, blood test analysis and multi-modality imaging tests (echocardiography, computed tomography, PET-CT, magnetic resonance) were collected. Primary endpoint was 30-day mortality. Multivariable logistic regression analysis was performed to assess variables associated with 30-day mortality. Besides, univariable analysis was performed to assess best vegetation size cut-off related to 30-day mortality.
Results
Among 2171 patients with left-side IE, 257 patients (11.8%) died during the first 30 days of IE diagnosis. Patient characteristics and univariable analysis are summarized in TABLE 1. Cut-off value for best vegetation size related to 30-day mortality was vegetation length >14mm, with a HR =2.00 (95% CI 1.59–2.51, p<0.0001) and a Harrell's Concordance of 0.58. After multivariable logistic regression analysis, factors associated with 30-day mortality risk were: vegetation size >14mm (OR =2.68, 95% CI [1.96–3.67], p<0.0001), previous stroke or transient ischemic attack (TIA) (OR =1.60, 95% CI [1.07–2.40], p=0.0235), creatinine >2mg/dL (OR =2.45, 95% CI [1.73–3.47], p<0.0001), presence of embolic events (OR =2.64, 95% CI [1.86–3.74], p<0.0001), hemorrhagic stroke (OR=3.71, 95% CI [1.80–7.64], p=0.0004), presence of heart failure or cardiogenic shock (OR =3.50, 95% CI [2.57–4.77], p<0.0001) and no cardiac surgery during the event (OR =4.07, 95% CI [2.93–5.67], p<0.0001). The C-statistic of the logistic model to predict 30-day mortality was 0.795.
Conclusion
Left-side infective endocarditis had a high 30-day mortality rate (11.8%). Presence of a large vegetation size (>14mm), embolic events, hemorrhagic stroke, renal failure, presence of heart failure or cardiogenic shock were associated with an increase in 30-day mortality. Performing cardiac surgery had a protective effect.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): ESC-EORP EURO-ENDO project from the ESC society
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Affiliation(s)
- A Sambola
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - J Lozano Torres
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - C Olmos
- Hospital Clinico San Carlos, Madrid, Spain
| | - J Ternacle
- Henri Mondor University Hospital Chenevier APHP, Creteil, France
| | | | | | | | | | - S W Park
- Asan Medical Center, Seoul, Korea (Republic of)
| | - S Bekkers
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - K L Chan
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - F Arregle
- APHM La Timone Hospital, Marseille, France
| | - B Lung
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Paris, France
| | | | - G Habib
- APHM La Timone Hospital, Marseille, France
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Sambola A, Lozano Torres J, Olmos C, Ternacle J, Calvo-Iglesias FE, Tribouilloy C, Reskovic Luksic V, Separovic-Hanzevacki J, Park SW, Bekkers S, Chan KL, Arregle F, Lung B, Lancellotti P, Habib G. Predictors of mortality in patients with right-side and cardiac device-related infective endocarditis, the esc-eorp euro-endo registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Mortality in right-sided infective endocarditis (RSIE) and cardiac device-related IE (CDRIE) rates have increased mainly due derived complications and heterogeneity of the disease. A better understanding of associated risk factors to mortality in these entities are required in order to develop an efficient therapy.
Purpose
The aim of this study was to assess 30-day mortality rate and variables associated in RSIE and CDRIE.
Methods
The ESC-EORP EURO-ENDO registry is a prospective multicenter observational study of patients presenting with definite or possible IE in Europe and ESC-affiliated/non-affiliated countries. Patients were included from January 2016 to 31 March 2018 in 156 centers from 40 countries. Clinical data, blood test analysis and multi-modality imaging tests (echocardiography, computed tomography, PET-CT, magnetic resonance) were collected. Primary endpoint was 30-day mortality. Univariable analysis was performed to assess variables associated with 30-day mortality.
Results
Among 269 patients with RSIE, 24 patients (9.8%) died during the first 30-day of IE diagnosis. Cut-off value for best vegetation size related to 30-day mortality was vegetation length >19mm, with a HR = 2.88 (95% CI 1.26–6.58, p=0.01) and a Harrell's Concordance of 0.632. Factors associated with 30-days mortality by univariable analysis were: vegetation size >19mm (OR = 2.99, 95% CI [1.31–6.84], p=0.009), previous stroke or transient ischemic attack (OR = 5.10, 95% CI [1.19–21.88], p=0.029), HIV infection (OR = 3.52, 95% CI [1.03–12.10], p=0.046), chronic renal failure (OR = 2.66, 95% CI [1.06–6.71], p=0.038), congestive heart failure at admission (OR = 2.34, 95% CI [1.00–5.47], p=0.050) and severe regurgitation (OR = 3.77, 95% CI [1.56–9.09], p=0.003).
On the other side, among the 227 patients with CDRIE, 24 patients (8.8%) died during the first 30-day of IE diagnosis. Factors associated with an increase in 30-day mortality by univariate analysis were: age per 10 years (OR = 1.49, 95% CI [1.02–2.18], p=0.039), heart failure history (OR = 3.88, 95% CI [1.39–10.80], p=0.009), congestive heart failure on admission (OR = 5.80, 95% CI [2.31–14.55], p<0.001) and cardiogenic shock on admission (OR = 13.37, 95% CI [3.75–47.64], p<0.001). An increase in left ventricular ejection fraction (LVEF) per 10% was a protective factor (OR = 0.66, 95% CI [0.49–0.90], p=0.008).
Conclusions
Patients with RSIE and CDRIE had a not negligible 30-day mortality rate (9.8% and 8.8%, respectively). Factors associated with RSIE and CDRIE mortality are different; while in the right side location, the mortality was related with vegetation size and comorbidities, in the case of CDRIE, the mortality was mainly associated to the presence of heart failure.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Euro-Endo registry by European Society of Cardiology
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Affiliation(s)
- A Sambola
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - J Lozano Torres
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - C Olmos
- Hospital Clinico San Carlos, Madrid, Spain
| | - J Ternacle
- University Hospital Henri Mondor, Creteil, France
| | | | | | | | | | - S W Park
- Asan Medical Center, Seoul, Korea (Republic of)
| | - S Bekkers
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - K L Chan
- Asan Medical Center, Seoul, Korea (Republic of)
| | - F Arregle
- APHM La Timone Hospital, Marseille, France
| | - B Lung
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Paris, France
| | | | - G Habib
- APHM La Timone Hospital, Marseille, France
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Delsing CP, Bekkers S, Erasmus CE, van Hulst K, van den Hoogen FJ. Posterior drooling in children with cerebral palsy and other neurodevelopmental disorders. Dev Med Child Neurol 2021; 63:1093-1098. [PMID: 33844298 DOI: 10.1111/dmcn.14888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 12/14/2022]
Abstract
AIM To evaluate the effect of botulinum neurotoxin A (BoNT-A) injections, submandibular gland excision (SMGE), and bilateral submandibular duct ligation (2DL) for the control of posterior drooling in children with neurological impairment. METHOD In a retrospective cohort, children with neurological impairment (e.g. cerebral palsy) treated between 2000 and 2016 were identified. Mean age at time of surgery was 9 years (range 1-21y). The primary outcome was posterior drooling severity by a visual analogue scale (VAS; 0-10) at baseline, 8-weeks, and 32-weeks follow-up. The secondary outcome was lower respiratory tract infections during the follow-up period. RESULTS Ninety-two patients (out of 475; 47 males, 45 females) were identified. They were undergoing three different treatments: BoNT-A (n=63), SMGE (n=16), and 2DL (n=13). A significant reduction in VAS over time was observed in the total group of 92 patients. After SMGE, VAS decreased significantly from 6.82 (SD 3.40) at baseline to 2.29 (SD 1.93) at 8 weeks, and 2.17 (SD 2.58) at 32 weeks (F[2.34]=11.618, p<0.001). There was no significant decrease after both BoNT-A and 2-DL. INTERPRETATION Posterior drooling is an unfamiliar, potentially life-threatening condition that is treatable with medication, BoNT-A injections, or surgery. Although all treatments reduced signs and symptoms of posterior drooling, there is a greater effect after SMGE compared to BoNT-A and 2-DL. What this paper adds Submandibular gland excision has better results for posterior drooling than botulinum toxin A or submandibular duct ligation.
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Affiliation(s)
- Corinne Pa Delsing
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Stijn Bekkers
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Corrie E Erasmus
- Department of Pediatric Neurology, Donders Institute for Medical Neurosciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Karen van Hulst
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank Ja van den Hoogen
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
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11
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Bekkers S, Leow TYS, Van Hulst K, Orriëns LB, Scheffer ART, Van Den Hoogen FJA. Repeated onabotulinum neurotoxin A injections for drooling in children with neurodisability. Dev Med Child Neurol 2021; 63:991-997. [PMID: 33772779 PMCID: PMC8359949 DOI: 10.1111/dmcn.14872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the effect of repeated onabotulinum neurotoxin A injections for the treatment of drooling in children with neurodisabilities. METHOD This was a retrospective cohort study, in which the first, second, and third onabotulinum neurotoxin A injection were compared within children treated between 2000 and 2020. Primary outcomes included drooling quotient, visual analogue scale (VAS), and treatment success defined as ≥50% reduction in drooling quotient and/or VAS 8 weeks after treatment. Each outcome was obtained at baseline and 8 weeks posttreatment. RESULTS Seventy-seven children were included (mean age at first injection: 8y 3mo, SD 3y 7mo, range 3-17y; 44 males, 33 females; 51.9% with cerebral palsy, 45.5% wheelchair-bound). The objective (drooling quotient) and subjective (VAS) effect after the second injection was lower compared to the first injection. The third injection showed less objective and significantly less subjective effect compared to the first injection. An overall success rate of 74.0%, 41.6%, and 45.8% were found for the first, second, and third injection respectively. INTERPRETATION Although onabotulinum neurotoxin A remained effective throughout the entire treatment course, there is less effect of subsequent onabotulinum neurotoxin A injections compared to the first. Although there might be a loss of effect after repeated injections, there is continued improvement for most children. What this paper adds Repeated injections show a diminished treatment effect after the second injection. A continued improvement is seen in most patients.
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Affiliation(s)
- Stijn Bekkers
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Theresa YS Leow
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Karen Van Hulst
- Department of RehabilitationRadboud University Medical CenterDonders Institute for Brain, Cognition and BehaviourNijmegenthe Netherlands
| | - Lynn B Orriëns
- Department of RehabilitationRadboud University Medical CenterDonders Institute for Brain, Cognition and BehaviourNijmegenthe Netherlands
| | - Arthur RT Scheffer
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Frank JA Van Den Hoogen
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud Institute for Health SciencesNijmegenthe Netherlands
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12
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Demirkiran A, Hoeven N, Janssens G, Lemkes J, Everaars H, Ven P, Cauteren Y, Leeuwen M, Nap A, Bekkers S, Royen N, Smulders M, Rossum A, Robbers L, Nijveldt R. Infarct characteristics and outcome of patients with transient ST-segment elevation myocardial infarction compared to ST-segment and non-ST-segment elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Up to one out of four patients with signs of ST-segment elevation myocardial infarction (STEMI) express complete normalization of ST elevation before primary revascularization procedure. This condition is commonly referred to as “transient ST-segment elevation myocardial infarction” (TSTEMI) and recent data suggests that this group of patients may have favorable outcome compared to STEMI patients. However, it is currently unknown how these patients compare to both STEMI and non-ST-segment elevation myocardial infarction (NSTEMI) patients with respect to infarct size characteristics and outcome.
Objective
This study aims to explore cardiac magnetic resonance (CMR) derived scar tissue and 1-year outcome in patients with TSTEMI by comparison to STEMI and NSTEMI.
Methods
Patients with STEMI were enrolled from two prospective studies (n=170); the patients with TSTEMI were recruited from the TRANSIENT trial (n=141); the patients with NSTEMI were prospectively and consecutively collected from local registries of Amsterdam UMC (n=57) and Maastricht UMC (n=51). All patients underwent CMR examination 2–8 days after the index event. Cine imaging was done for volume and function assessment. Late gadolinium enhancement imaging was performed to identify infarct size (in grams) and the presence of microvascular obstruction (MVO). All CMR images were processed in a single core laboratory (Amsterdam UMC). Clinical outcome after 1 year was measured by the incidence of major adverse cardiac events (MACE), defined as recurrent myocardial infarction (MI), revascularization and all cause death.
Results
The TSTEMI group demonstrated the lowest end-systolic left ventricular volume and highest left ventricular ejection fraction across the groups (overall p<0.001). Although there was a remarkably lower infarct size in TSTEMI patients compared to STEMI (1.41g [0.00–3.91] vs 13.48g [5.31–26.81], p<0.001), there was only a trend towards lower infarct size compared to NSTEMI patients (1.41g [0.00–3.91] vs 2.13g [0.00–8.64], p=0.06). Whilst MVO was observed less frequently in TSTEMI compared to STEMI patients (5 (4%) vs 53 (31%), p<0.001), no significant difference was seen between TSTEMI and NSTEMI patients (5 (4%) vs 5 (5%), p=0.72). Multivariable linear regression analysis identified infarct type, smoking, peak troponin-T and pre-PCI TIMI flow as predictors for infarct size (p=0.03, p=0.03, p<0.001 and p<0.001, respectively). One-year mortality rate was low in all 3 MI types (TSTEMI 3 (2.2%), NSTEMI 3 (3.1%), 4 (2.4%), log-rank test p=0.91). However, there was a significant difference in MACE at 1 year across the 3 MI types (TSTEMI 18 (13.2%), NSTEMI 19 (19.4%), STEMI 11 (6.7%), overall p<0.01).
Conclusion
In comparison to NSTEMI and STEMI, TSTEMI yielded favorable cardiac left ventricular function and scar mass. However, this did not lead to benefit in short term (1-year) outcome; further studies are needed with longer follow-up.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): European Association of Cardiovascular Imaging (EACVI) Research Grant
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Affiliation(s)
- A Demirkiran
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Cardiology, Amsterdam, Netherlands (The)
| | - N Hoeven
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Cardiology, Amsterdam, Netherlands (The)
| | - G Janssens
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Cardiology, Amsterdam, Netherlands (The)
| | - J Lemkes
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Cardiology, Amsterdam, Netherlands (The)
| | - H Everaars
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Cardiology, Amsterdam, Netherlands (The)
| | - P Ven
- Amsterdam UMC - Location VUmc, Epidemiology and biostatistics, Amsterdam, Netherlands (The)
| | - Y Cauteren
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - M Leeuwen
- Isala Hospital, Cardiology, Zwolle, Netherlands (The)
| | - A Nap
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Cardiology, Amsterdam, Netherlands (The)
| | - S Bekkers
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - N Royen
- Radboud University Medical Centre, Cardiology, Nijmegen, Netherlands (The)
| | - M Smulders
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - A Rossum
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Cardiology, Amsterdam, Netherlands (The)
| | - L Robbers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Cardiology, Amsterdam, Netherlands (The)
| | - R Nijveldt
- Radboud University Medical Centre, Cardiology, Nijmegen, Netherlands (The)
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Bekkers S, van Ulsen KJ, M M Adang E, R T Scheffer A, J A van den Hoogen F. Cost-effectiveness of botulinum neurotoxin A versus surgery for drooling: a randomized clinical trial. Dev Med Child Neurol 2020; 62:1302-1308. [PMID: 32706122 PMCID: PMC7589433 DOI: 10.1111/dmcn.14636] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 11/27/2022]
Abstract
AIM This study compared the cost-effectiveness of botulinum neurotoxin A (BoNT-A) injections with two-duct ligation of the submandibular glands as treatment for severe drooling after one treatment cycle. METHOD The study was part of a larger, partly single-blinded, randomized clinical trial (trialregister.nl identifier NTR3537). Data were collected between 2012 and 2017. Evaluation was at 32 weeks after one treatment cycle. Fifty-seven patients with cerebral palsy or other neurological, non-progressive disorders and severe drooling classified as having a drooling frequency ≥3 or a drooling severity ≥2, in whom conservative treatment was deemed ineffective, were randomized to treatment by BoNT-A or two-duct ligation. An incremental cost-effectiveness ratio (ICER) was calculated using the success rates as the measure of benefit. Treatment success was defined as a decrease ≥50% from baseline to 32 weeks in the subjective visual analogue scale for the severity of drooling or the objective drooling quotient. RESULTS Fifty-three patients were analysed (22 females, 31 males; mean age 11y, range 8-22y). Average costs for one treatment cycle, which included one BoNT-A injection, were €1929 (standard error 62) for BoNT-A and €3155 (standard error 99) for two-duct ligation. Treatment success was in favour of two-duct ligation (63% vs 27%; number needed to treat 3). The ICER was €34 per 1% gain in treatment success in favour of two-duct ligation versus BoNT-A. INTERPRETATION The additional cost of two-duct ligation is to some extent offset by a larger treatment success rate compared with BoNT-A. WHAT THIS PAPER ADDS Botulinum neurotoxin A (BoNT-A) is less expensive per percentage of success than two-duct ligation. The additional cost of two-duct ligation over BoNT-A is offset by greater treatment success.
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Affiliation(s)
- Stijn Bekkers
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Kim J van Ulsen
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Eddy M M Adang
- Department for Health Evidence RehabilitationRadboud University Medical CenterNijmegenthe Netherlands
| | - Arthur R T Scheffer
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
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Bekkers S, Pruijn IMJ, Van Hulst K, Delsing CP, Erasmus CE, Scheffer ART, Van Den Hoogen FJA. Submandibular duct ligation after botulinum neurotoxin A treatment of drooling in children with cerebral palsy. Dev Med Child Neurol 2020; 62:861-867. [PMID: 32149393 PMCID: PMC7318229 DOI: 10.1111/dmcn.14510] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
AIM To assess: (1) the effect on drooling of bilateral submandibular duct ligation as surgical therapy after the administration of submandibular botulinum neurotoxin A (BoNT-A) for excessive drooling and (2) the predictive value of treatment success with BoNT-A on treatment success after bilateral submandibular duct ligation. METHOD This was a within-participant retrospective observational study in which 29 children with severe drooling (15 males, 14 females) received BoNT-A treatment at a mean age of 9 years 6 months (SD 2y 5mo), followed by bilateral submandibular duct ligation at a mean age of 10 years 11 months (SD 2y 4mo). Fifteen children were diagnosed with cerebral palsy (CP), with 12 children classified in Gross Motor Function Classification System levels IV and V. The 14 children without CP had non-progressive developmental disorders. The primary drooling severity outcomes were the Visual Analogue Scale (VAS; subjective assessment) and drooling quotient (objective assessment). Measurements were taken before each intervention and again at 8 and 32 weeks. RESULTS The VAS was significantly lower after bilateral submandibular duct ligation at follow-up compared to BoNT-A treatment (mean difference -33, p≤0.001; 95% confidence interval [CI]=-43.3 to -22.9). The mean drooling quotient did not significantly differ between BoNT-A treatment and bilateral submandibular duct ligation at follow-up (3.3, p=0.457; 95% CI=-4.35 to 9.62) or between 8 and 32 weeks (4.7, p=0.188; 95% CI=-2.31 to 11.65). INTERPRETATION BoNT-A treatment and bilateral submandibular duct ligation are both effective treatment modalities for drooling. At 32-week follow-up, subjective drooling severity after bilateral submandibular duct ligation was significantly lower compared to previous BoNT-A injections in participants. However, treatment success with BoNT-A is no precursor to achieving success with bilateral submandibular duct ligation. WHAT THIS PAPER ADDS Bilateral submandibular duct ligation is an effective therapy for drooling after treatment with botulinum neurotoxin A (BoNT-A). Treatment success with BoNT-A is not a predictor of successful therapy with bilateral submandibular duct ligation.
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Affiliation(s)
- Stijn Bekkers
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Ineke M J Pruijn
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Karen Van Hulst
- Department of RehabilitationDonders Institute for BrainCognition and BehaviourRadboud University Medical CenterNijmegenthe Netherlands
| | - Corinne P Delsing
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Corrie E Erasmus
- Department of Paediatric NeurologyDonders Center for NeuroscienceRadboud University Medical CenterNijmegenthe Netherlands
| | - Arthur R T Scheffer
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Frank J A Van Den Hoogen
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
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Affiliation(s)
- Tim Willegers
- Radboud University/Radboud University Medical Center
| | - Jimmie Honings
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Stijn Bekkers
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
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16
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Phijffer EWEM, Bekkers S, Antonius van den Hoogen FJ. Novel Treatment Option for a Lateral Pharyngeal Diverticulum. Ear Nose Throat J 2019; 99:183-184. [PMID: 30961376 DOI: 10.1177/0145561319841206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Stijn Bekkers
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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17
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Bekkers S, Delsing CP, Kok SE, van Hulst K, Erasmus CE, Scheffer ART, van den Hoogen FJA. Randomized controlled trial comparing botulinum vs surgery for drooling in neurodisabilities. Neurology 2019; 92:e1195-e1204. [PMID: 30728311 DOI: 10.1212/wnl.0000000000007081] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 11/04/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the effect of submandibular duct ligation (2-DL) and submandibular botulinum neurotoxin type A (BoNT-A) for drooling in children and adolescents with neurodevelopmental disabilities. METHODS A randomized, interventional, controlled, and partly single-blinded study was performed in which submandibular BoNT-A was compared with 2-DL to treat excessive drooling. Main outcomes included a Visual Analog Scale (VAS), drooling quotient (DQ), drooling severity (DS) scale and drooling frequency (DF) scale. Each was obtained at baseline, and 8 and 32 weeks post treatment. RESULTS Fifty-seven patients (mean age: 11 years, mean baseline VAS score 7.9, mean baseline DQ 27.3%) were randomized to the 2-DL or BoNT-A group. Four patients were excluded from analyses, leaving 53 patients for intention-to-treat analyses. Response to treatment, defined as a ≥50% reduction in DQ or VAS score, was higher for 2-DL after 32 weeks (63.0% vs 26.9%, p = 0.008). Both VAS score (24.5, p < 0.001) and DQ (-9.3%, p = 0.022) were significantly lower at follow-up after 2-DL vs BoNT-A. The total number of adverse events (p = 0.088, 40.7% vs 19.2%) and postoperative complaints was higher (p < 0.001, mean 9.6 vs 3.6 days) for 2-DL than for BoNT-A. CONCLUSION The 2-DL procedure is a more effective treatment for drooling than botulinum toxin, but carries a slightly greater risk of complications and morbidity. TRIALREGISTERNL IDENTIFIER NTR3537. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that for children and adolescents with neurodevelopmental disabilities and severe drooling, 2-DL compared to a one-time intraglandular BoNT-A injection is more effective at reducing drooling at 32 weeks.
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Affiliation(s)
- Stijn Bekkers
- From the Department of Otorhinolaryngology and Head and Neck Surgery (S.B., C.P.D., S.E.K., A.R.T.S., F.J.A.v.d.H.), Radboud University Medical Centre, Nijmegen; and Departments of Rehabilitation (K.v.H.) and Paediatric Neurology (C.E.E.), Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - Corinne P Delsing
- From the Department of Otorhinolaryngology and Head and Neck Surgery (S.B., C.P.D., S.E.K., A.R.T.S., F.J.A.v.d.H.), Radboud University Medical Centre, Nijmegen; and Departments of Rehabilitation (K.v.H.) and Paediatric Neurology (C.E.E.), Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Saskia E Kok
- From the Department of Otorhinolaryngology and Head and Neck Surgery (S.B., C.P.D., S.E.K., A.R.T.S., F.J.A.v.d.H.), Radboud University Medical Centre, Nijmegen; and Departments of Rehabilitation (K.v.H.) and Paediatric Neurology (C.E.E.), Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Karen van Hulst
- From the Department of Otorhinolaryngology and Head and Neck Surgery (S.B., C.P.D., S.E.K., A.R.T.S., F.J.A.v.d.H.), Radboud University Medical Centre, Nijmegen; and Departments of Rehabilitation (K.v.H.) and Paediatric Neurology (C.E.E.), Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Corrie E Erasmus
- From the Department of Otorhinolaryngology and Head and Neck Surgery (S.B., C.P.D., S.E.K., A.R.T.S., F.J.A.v.d.H.), Radboud University Medical Centre, Nijmegen; and Departments of Rehabilitation (K.v.H.) and Paediatric Neurology (C.E.E.), Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Arthur R T Scheffer
- From the Department of Otorhinolaryngology and Head and Neck Surgery (S.B., C.P.D., S.E.K., A.R.T.S., F.J.A.v.d.H.), Radboud University Medical Centre, Nijmegen; and Departments of Rehabilitation (K.v.H.) and Paediatric Neurology (C.E.E.), Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank J A van den Hoogen
- From the Department of Otorhinolaryngology and Head and Neck Surgery (S.B., C.P.D., S.E.K., A.R.T.S., F.J.A.v.d.H.), Radboud University Medical Centre, Nijmegen; and Departments of Rehabilitation (K.v.H.) and Paediatric Neurology (C.E.E.), Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
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Bekkers S, Rijken JA, Daniels JMA, Rinkel RNPM, Hendrickx JJ, Eerenstein SEJ. Silver Nitrate Aspiration: A Potentially Life-Threatening Complication. Am J Respir Crit Care Med 2017; 195:e43-e46. [DOI: 10.1164/rccm.201603-0625im] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Stijn Bekkers
- Department of Otolaryngology-Head and Neck Surgery and
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Bekkers S, Vranceanu AM, Ring D. Response letter regarding the Clinical Commentary. J Hand Ther 2015; 27:298. [PMID: 25220714 DOI: 10.1016/j.jht.2014.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 07/19/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Stijn Bekkers
- Massachusetts General Hospital, Department of Orthopaedic Surgery, Yawkee Center, Suite 2100, 55 Fruit St., Boston, MA 02114, USA
| | - Ana-Maria Vranceanu
- Massachusetts General Hospital, Department of Orthopaedic Surgery, Yawkee Center, Suite 2100, 55 Fruit St., Boston, MA 02114, USA
| | - David Ring
- Massachusetts General Hospital, Department of Orthopaedic Surgery, Yawkee Center, Suite 2100, 55 Fruit St., Boston, MA 02114, USA.
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20
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Bekkers S, Becker SJE, Bossen JKJ, Mudgal CS, Ring D, Vranceanu AM. Relationships between pain misconceptions, disability, patients' goals and interpretation of information from hand therapists. J Hand Ther 2015; 27:287-94; quiz 295. [PMID: 25064147 DOI: 10.1016/j.jht.2014.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 04/27/2014] [Accepted: 06/12/2014] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Patient interpretation of advice from hand therapists may be related to nonadaptive pain thoughts (automatic, overprotective, unduly pessimistic statements triggered by nociception and exacerbated by psychological distress). PURPOSE OF THE STUDY This study aimed to determine whether there were correlations between participants' hand therapy goals, interpretation of advice from hand therapists, nonadaptive pain thoughts, and upper extremity-specific disability. METHODS One hundred and five participants completed questionnaires assessing nonadaptive pain thoughts, upper extremity-specific disability, lessons from hand therapists, and hand therapy goals. RESULTS Nonadaptive pain thoughts correlated with disability and were bi-directionally related to participant goals and interpretation of advice from hand therapists. DISCUSSION Patients' nonadapative pain thoughts and the words/concepts used by hand therapists are both important in recovery from upper extremity illness. CONCLUSIONS Hand therapists should be mindful that nonadaptive pain thoughts are an important determinant of disability and that such thoughts can affect and be affected by their recommendations. LEVEL OF EVIDENCE n/a.
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Affiliation(s)
- Stijn Bekkers
- Department of Orthopaedic Surgery, Harvard Medical School, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Stéphanie J E Becker
- Department of Orthopaedic Surgery, Harvard Medical School, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jeroen K J Bossen
- Department of Orthopaedic Surgery, Harvard Medical School, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Chaitanya S Mudgal
- Department of Orthopaedic Surgery, Harvard Medical School, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA
| | - David Ring
- Department of Orthopaedic Surgery, Harvard Medical School, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA.
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Harvard Medical School, Behavioral Medicine Service, Massachusetts General Hospital, Boston, MA 02114, USA
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21
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Bekkers S, Bot AGJ, Makarawung D, Neuhaus V, Ring D. The National Hospital Discharge Survey and Nationwide Inpatient Sample: the databases used affect results in THA research. Clin Orthop Relat Res 2014; 472:3441-9. [PMID: 25091226 PMCID: PMC4182371 DOI: 10.1007/s11999-014-3836-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 07/21/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND The National Hospital Discharge Survey (NHDS) and the Nationwide Inpatient Sample (NIS) collect sample data and publish annual estimates of inpatient care in the United States, and both are commonly used in orthopaedic research. However, there are important differences between the databases, and because of these differences, asking these two databases the same question may result in different answers. The degree to which this is true for arthroplasty-related research has, to our knowledge, not been characterized. QUESTION/PURPOSES We tested the following null hypotheses: (1) there are no differences between the NHDS and NIS in patient characteristics, comorbidities, and adverse events in patients with hip osteoarthritis treated with THA, and (2) there are no differences between databases in factors associated with inpatient mortality, adverse events, and length of hospital stay after THA. METHODS The NHDS and NIS databases use different methods of data collection and weighting to provide data representative of all nonfederal hospital discharges in the United States. In 2006 the NHDS database contained 203,149 patients with hip arthritis treated with hip arthroplasty, and the NIS database included 193,879 patients. Multivariable analyses for factors associated with inpatient mortality, adverse events, and days of care were constructed for each database. RESULTS We found that 26 of 42 of the factors in demographics, comorbidities, and adverse events after THA in the NIS and NHDS databases differed more than 10%. Age and days of care were associated with inpatient mortality with the NHDS and the NIS although the effect rates differ more than 10%. The NIS identified seven other factors not identified by the NHDS: wound complications, congestive heart failure, new mental disorder, chronic pulmonary disease, dementia, geographic region Northeast, acute postoperative anemia, and sex, that were associated with inpatient mortality even after controlling for potentially confounding variables. For inpatient adverse events, atrial fibrillation, osteoporosis, and female sex were associated with the NHDS and the NIS although the effect rates differ more than 10%. There were different directions for sources of payment, dementia, congestive heart failure, and geographic region. For longer length of stay, common factors differing more than 10% in effect rate included chronic pulmonary disease, atrial fibrillation, complication not elsewhere classified, congestive heart failure, transfusion, discharge nonroutine compared with routine, acute postoperative anemia, hypertension, wound adverse events, and diabetes mellitus, whereas discrepant factors included geographic region, payment method, dementia, sex, and iatrogenic hypotension. CONCLUSIONS Studies that use large databases intended to be representative of the entire United States population can produce different results, likely related to differences in the databases, such as the number of comorbidities and procedures that can be entered in the database. In other words, analyses of large databases can have limited reliability and should be interpreted with caution. LEVEL OF EVIDENCE Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Stijn Bekkers
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - Arjan G. J. Bot
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - Dennis Makarawung
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - Valentin Neuhaus
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
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Bot AGJ, Bekkers S, Herndon JH, Mudgal CS, Jupiter JB, Ring D. Determinants of disability after proximal interphalangeal joint sprain or dislocation. Psychosomatics 2014; 55:595-601. [PMID: 25034813 DOI: 10.1016/j.psym.2014.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 01/10/2014] [Accepted: 01/13/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sprain or dislocation of the proximal interphalangeal joint may be a useful example of the counterintuitive aspects of recovery as the prognosis is excellent, but protectiveness in response to discomfort often hinders the stretching exercises that are a key component of the recovery process. OBJECTIVE The aim of this study was to investigate the relationship between disability and pain self-efficacy in this context. METHODS A total of 82 patients (54 men and 28 women) were enrolled in this prospective study. Finger motion was measured, and the patients completed measures of upper limb-specific disability (the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire), symptoms of depression (Patient Health Questionnaire-9), effective coping strategies in response to pain (the Pain Self-Efficacy Questionnaire), and a pain scale at enrollment. RESULTS Patients were enrolled a mean of 48 days after injury. The final multivariable model accounting for greater disability included lower self-efficacy, greater symptoms of depression, and gender (women have more disability). Lower self-efficacy was also the strongest predictor of pain intensity and finger stiffness. CONCLUSIONS Effective coping strategies such as self-efficacy facilitate recovery (less disability, pain, and stiffness) after proximal interphalangeal joint sprain/dislocation. LEVEL OF EVIDENCE Prognostic level I.
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Affiliation(s)
| | | | | | | | | | - David Ring
- Massachusetts General Hospital, Boston, MA
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Makarawung DJS, Becker SJE, Bekkers S, Ring D. Disability and pain after cortisone versus placebo injection for trapeziometacarpal arthrosis and de Quervain syndrome. Hand (N Y) 2013; 8:375-81. [PMID: 24426952 PMCID: PMC3840768 DOI: 10.1007/s11552-013-9529-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study tested the null hypothesis that type of injection (corticosteroid vs. placebo) is not a predictor of arm-specific disability as measured with the Disabilities of Arm, Shoulder and Hand questionnaire 1 to 3 months after injection of dexamethasone or placebo for treatment of trapeziometacarpal (TMC) arthrosis or de Quervain syndrome. Secondly, we tested if type of injection was a predictor of pain intensity. METHODS Thirty-six English-speaking adults with TMC arthrosis or de Quervain syndrome were randomized for a dexamethasone or a placebo injection. At time of the injection, patients completed a demographic data sheet and validated questionnaires assessing arm-specific disability, pain intensity, depressive symptoms, pain catastrophizing, and patient's health-related beliefs. At an average of 1.4 ± 0.42 months (range, 0.79-2.5 months) after the injection, patients completed questionnaires regarding arm-specific disability, pain, and treatment satisfaction. Grip and pinch strength measurements were measured at both time points. Bivariable and multivariable analyses assessed predictors of arm-specific disability and pain intensity at follow-up. RESULTS Type of injection was not a predictor of arm-specific disability or pain intensity 1 to 3 months after injection. The best model both for arm-specific disability and pain intensity at follow-up included pain catastrophizing and explained 18 % and 33 % of the variability, respectively. CONCLUSIONS Catastrophic thinking was a better predictor of both of arm-specific disability and pain intensity than diagnosis or type of injection (steroid vs. placebo) 1to 3 months after an injection.
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Affiliation(s)
- Dennis J. S. Makarawung
- MGH Hand Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - Stéphanie J. E. Becker
- MGH Hand Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - Stijn Bekkers
- MGH Hand Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - David Ring
- MGH Hand Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
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