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Tang YH, Vos LM, Tuin AJ, Huddleston Slater JJR, Gareb B, van Bakelen NB, Spijkervet FKL. Arthrocentesis versus non-surgical intervention as initial treatment for temporomandibular joint arthralgia: a randomized controlled trial with long-term follow-up. Int J Oral Maxillofac Surg 2022; 52:595-603. [PMID: 36117007 DOI: 10.1016/j.ijom.2022.08.018] [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: 03/04/2022] [Revised: 07/19/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022]
Abstract
Arthrocentesis for arthralgia of the temporomandibular joint (TMJ) is often only indicated when conservative, non-surgical interventions have failed. However, performing arthrocentesis as initial therapy may facilitate earlier and better recuperation of the joint. The aim of this study was to assess the efficacy of this therapy with a long-term follow-up. Eighty-four patients were randomly allocated to receive either arthrocentesis as initial treatment (n = 41) or non-surgical intervention (n = 43). Pain (100-mm visual analogue scale, VAS) and mandibular function impairment questionnaire scores (MFIQ, 0-100) were recorded at 3, 12, and 26 weeks, and ≥ 5 years (median 6.2, interquartile range 5.6-7.4 years). Univariable analyses were performed and linear mixed-effect models were constructed. Patients in the arthrocentesis group experienced significantly lower TMJ arthralgia compared to those treated non-surgically (pain during movement: -10.23 mm (95% confidence interval -17.86; -2.60); pain at rest: - 8.39 mm (95% confidence interval -13.70; -3.08)), while mandibular function remained similar in the two groups (MFIQ -2.41 (95% confidence interval -8.61; 3.78)). Of the final sample, 10 patients (10/39, 26%) in the non-surgical intervention group and two patients (2/34, 6%) in the arthrocentesis group received additional treatment during follow-up. Thus, initial treatment with arthrocentesis reduced TMJ arthralgia more efficaciously than non-surgical intervention in the long term, while maintaining similar mandibular function.
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Affiliation(s)
- Y H Tang
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - L M Vos
- Department of Oral and Maxillofacial Surgery, Wilhelmina Hospital Assen, Assen, the Netherlands
| | - A J Tuin
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - J J R Huddleston Slater
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - B Gareb
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - N B van Bakelen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - F K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Vos LM, Teirlinck AC, Lozano JE, Vega T, Donker GA, Hoepelman AI, Bont LJ, Oosterheert JJ, Meijer A. Use of the moving epidemic method (MEM) to assess national surveillance data for respiratory syncytial virus (RSV) in the Netherlands, 2005 to 2017. ACTA ACUST UNITED AC 2020; 24. [PMID: 31115311 PMCID: PMC6530251 DOI: 10.2807/1560-7917.es.2019.24.20.1800469] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background To control respiratory syncytial virus (RSV), which causes acute respiratory infections, data and methods to assess its epidemiology are important. Aim We sought to describe RSV seasonality, affected age groups and RSV-type distribution over 12 consecutive seasons in the Netherlands, as well as to validate the moving epidemic method (MEM) for monitoring RSV epidemics. Methods We used 2005−17 laboratory surveillance data and sentinel data. For RSV seasonality evaluation, epidemic thresholds (i) at 1.2% of the cumulative number of RSV-positive patients per season and (ii) at 20 detections per week (for laboratory data) were employed. We also assessed MEM thresholds. Results In laboratory data RSV was reported 25,491 times (no denominator). In sentinel data 5.6% (767/13,577) of specimens tested RSV positive. Over 12 seasons, sentinel data showed percentage increases of RSV positive samples. The average epidemic length was 18.0 weeks (95% confidence intervals (CI): 16.3–19.7) and 16.5 weeks (95% CI: 14.0–18.0) for laboratory and sentinel data, respectively. Epidemics started on average in week 46 (95% CI: 45–48) and 47 (95% CI: 46–49), respectively. The peak was on average in the first week of January in both datasets. MEM showed similar results to the other methods. RSV incidence was highest in youngest (0–1 and >1–2 years) and oldest (>65–75 and > 75 years) age groups, with age distribution remaining stable over time. RSV-type dominance alternated every one or two seasons. Conclusions Our findings provide baseline information for immunisation advisory groups. The possibility of employing MEM to monitor RSV epidemics allows prospective, nearly real-time use of surveillance data.
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Affiliation(s)
- Laura M Vos
- University Medical Centre Utrecht, Utrecht University, Department of Internal Medicine and Infectious Diseases, Utrecht, the Netherlands
| | - Anne C Teirlinck
- Centre for infectious Disease Control Bilthoven, Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - José E Lozano
- Dirección General de Salud Pública, Consejería de Sanidad, Valladolid, Spain
| | - Tomás Vega
- Dirección General de Salud Pública, Consejería de Sanidad, Valladolid, Spain
| | - Gé A Donker
- NIVEL Primary Care Database - Sentinel Practices, Utrecht, the Netherlands
| | - Andy Im Hoepelman
- University Medical Centre Utrecht, Utrecht University, Department of Internal Medicine and Infectious Diseases, Utrecht, the Netherlands
| | - Louis J Bont
- Wilhelmina Children's Hospital, Utrecht University, Department of Paediatric Infectious Diseases, Utrecht, the Netherlands
| | - Jan Jelrik Oosterheert
- University Medical Centre Utrecht, Utrecht University, Department of Internal Medicine and Infectious Diseases, Utrecht, the Netherlands
| | - Adam Meijer
- Centre for infectious Disease Control Bilthoven, Centre for Infectious Diseases Research, Diagnostics and laboratory Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Vos LM, Bruning AHL, Reitsma JB, Schuurman R, Riezebos-Brilman A, Hoepelman AIM, Oosterheert JJ. Rapid Molecular Tests for Influenza, Respiratory Syncytial Virus, and Other Respiratory Viruses: A Systematic Review of Diagnostic Accuracy and Clinical Impact Studies. Clin Infect Dis 2019; 69:1243-1253. [PMID: 30689772 PMCID: PMC7108200 DOI: 10.1093/cid/ciz056] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/16/2019] [Indexed: 01/03/2023] Open
Abstract
We systematically reviewed available evidence from Embase, Medline, and the Cochrane Library on diagnostic accuracy and clinical impact of commercially available rapid (results <3 hours) molecular diagnostics for respiratory viruses as compared to conventional molecular tests. Quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies criteria for diagnostic test accuracy (DTA) studies, and the Cochrane Risk of Bias Assessment and Risk of Bias in Nonrandomized Studies of Interventions criteria for randomized and observational impact studies, respectively. Sixty-three DTA reports (56 studies) were meta-analyzed with a pooled sensitivity of 90.9% (95% confidence interval [CI], 88.7%-93.1%) and specificity of 96.1% (95% CI, 94.2%-97.9%) for the detection of either influenza virus (n = 29), respiratory syncytial virus (RSV) (n = 1), influenza virus and RSV (n = 19), or a viral panel including influenza virus and RSV (n = 14). The 15 included impact studies (5 randomized) were very heterogeneous and results were therefore inconclusive. However, we suggest that implementation of rapid diagnostics in hospital care settings should be considered.
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Affiliation(s)
- Laura M Vos
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Andrea H L Bruning
- Department of Medical Microbiology, Amsterdam University Medical Center, University of Amsterdam, The Netherlands
| | | | - Rob Schuurman
- Department of Microbiology and Virology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Annelies Riezebos-Brilman
- Department of Microbiology and Virology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Andy I M Hoepelman
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Jan Jelrik Oosterheert
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht University, The Netherlands
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Vos LM, Oosterheert JJ, Hoepelman AIM, Bont LJ, Coenjaerts FEJ, Naaktgeboren CA. External validation and update of a prognostic model to predict mortality in hospitalized adults with RSV: A retrospective Dutch cohort study. J Med Virol 2019; 91:2117-2124. [PMID: 31410862 PMCID: PMC6851775 DOI: 10.1002/jmv.25568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/03/2019] [Indexed: 01/14/2023]
Abstract
Respiratory syncytial virus (RSV) causes significant mortality in hospitalized adults. Prediction of poor outcomes improves targeted management and clinical outcomes. We externally validated and updated existing models to predict poor outcome in hospitalized RSV-infected adults. In this single center, retrospective, observational cohort study, we included hospitalized adults with respiratory tract infections (RTIs) and a positive polymerase chain reaction for RSV (A/B) on respiratory tract samples (2005-2018). We validated existing prediction models and updated the best discriminating model by revision, recalibration, and incremental value testing. We included 192 RSV-infected patients (median age 60.7 years, 57% male, 65% immunocompromised, and 43% with lower RTI). Sixteen patients (8%) died within 30 days. During hospitalization, 16 (8%) died, 30 (16%) were admitted to intensive care unit, 21 (11%) needed invasive mechanical ventilation, and 5 (3%) noninvasive positive pressure ventilation. Existing models performed moderately at external validation, with C-statistics 0.6 to 0.7 and moderate calibration. Updating to a model including lower RTI, chronic pulmonary disease, temperature, confusion and urea, increased the C-statistic to 0.76 (95% confidence interval, 0.61-0.91) to predict in-hospital mortality. In conclusion, existing models to predict poor prognosis among hospitalized RSV-infected adults perform moderately at external validation. A prognostic model may help to identify and treat RSV-infected adults at high-risk of death.
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Affiliation(s)
- Laura M Vos
- Department of Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan Jelrik Oosterheert
- Department of Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Andy I M Hoepelman
- Department of Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Louis J Bont
- Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frank E J Coenjaerts
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Christiana A Naaktgeboren
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Vos LM, Oosterheert JJ. Testing for viral infections in severe lower respiratory tract infections; the unpredictable effects of diagnostic certainty. Clin Microbiol Infect 2019; 25:1302-1303. [PMID: 31401176 DOI: 10.1016/j.cmi.2019.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 11/19/2022]
Affiliation(s)
- L M Vos
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J J Oosterheert
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands.
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6
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Vos LM, Oosterheert JJ, Kuil SD, Viveen M, Bont LJ, Hoepelman AIM, Coenjaerts FEJ. High epidemic burden of RSV disease coinciding with genetic alterations causing amino acid substitutions in the RSV G-protein during the 2016/2017 season in The Netherlands. J Clin Virol 2019; 112:20-26. [PMID: 30708281 DOI: 10.1016/j.jcv.2019.01.007] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/11/2019] [Accepted: 01/20/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND We found amino acid substitutions in the Gglycoprotein of respiratory syncytial virus (RSV) A during the 2016/2017 epidemic in The Netherlands. OBJECTIVES We evaluated whether these alterations led to increased RSV incidence and disease burden. STUDY DESIGN We sequenced the gene encoding the G-protein of prospectively collected clinical specimens from secondary care adult patients testing positive for RSV during the 2016/2017 and 2017/2018 epidemic RSV season. We evaluated associations between genetic, clinical and epidemiological data. RESULTS We included 49 RSV strains. In 2016/2017 28 strains were included, 20 community acquired RSV-A, 5 hospital acquired RSV-A and 3 community acquired RSV-B. In 2017/2018 21 strains were included, 8 community acquired RSV-A and 13 community acquired RSV-B. G-proteins of 10 out of the 20 community acquired 2016/2017 RSV-A strains shared a set of eight novel amino acid substitutions of which seven in mucin-like regions 1 and 2 and one in the heparin binding domain. This genetic variant was no longer detected among 2017/2018 RSV-A strains. Among patients carrying the novel RSV-A strain-type, 30% died. CONCLUSIONS A set of eight amino acid substitutions was found in 50% of the 2016/2017 community acquired RSV-A G-proteins. This combination of substitutions was globally never observed before. The appearance of this new strain-type coincided with an increased RSV peak in The Netherlands and was associated with higher disease severity. The transient character of this epidemic strain-type suggests rapid clearance of this lineage in our study community.
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Affiliation(s)
- Laura M Vos
- University Medical Center Utrecht, Utrecht University, Department of Internal Medicine and Infectious Diseases, Utrecht 3584 CX, The Netherlands.
| | - Jan Jelrik Oosterheert
- University Medical Center Utrecht, Utrecht University, Department of Internal Medicine and Infectious Diseases, Utrecht 3584 CX, The Netherlands
| | - Sacha D Kuil
- Academic Medical Center Amsterdam, Department of Medical Microbiology, Laboratory of Clinical Virology, Amsterdam 1105 AZ, The Netherlands
| | - Marco Viveen
- University Medical Center Utrecht, Utrecht University, Department of Medical Microbiology, Utrecht 3584 CX, The Netherlands
| | - Louis J Bont
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Department of Pediatric Infectious Diseases, Utrecht 3584 EA, The Netherlands
| | - Andy I M Hoepelman
- University Medical Center Utrecht, Utrecht University, Department of Internal Medicine and Infectious Diseases, Utrecht 3584 CX, The Netherlands
| | - Frank E J Coenjaerts
- University Medical Center Utrecht, Utrecht University, Department of Medical Microbiology, Utrecht 3584 CX, The Netherlands
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7
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Vos LM, Riezebos-Brilman A, Schuurman R, Hoepelman AIM, Oosterheert JJ. Syndromic sample-to-result PCR testing for respiratory infections in adult patients. Neth J Med 2018; 76:286-293. [PMID: 30152393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Syndromic sample-to-result (SS2R) poly merase chain reaction (PCR) can rapidly identify causative pathogens of respiratory tract infections (RTI). We evaluated diagnostic accuracy and applicability of one of the current SS2R diagnostics, the FilmArray® Respiratory Viral Panel. METHODS We performed a prospective study among adults presenting with symptoms of RTI at the Emergency Department of the University Medical Centre Utrecht (the Netherlands) during the 2016-2017 viral respiratory season. Clinical data were collected. We compared SS2R results on nasopharyngeal swabs to conventional real time PCR, calculated turnaround times (TAT) and explored implementation barriers using questionnaires. RESULTS 62 Patients were included (64.5 yr [interquartile range (IQR) 44.3-75.0]). SS2R sensitivity was 82.9% [95% confidence interval (CI) 67.9-92.9] and specificity was 95.2% [95% CI 76.2-99.9] for detection of all present viruses (n = 60). Kappa agreement (0.73 [95% CI 0.56-0.90]) was good (p = 0.000). Median SS2R TAT was 2:06 hours [IQR 1:45-3:17] compared to 32:00 hours [IQR 26:50-40:42] of conventional PCR (n = 49, p = 0.000). Ease-of-use and fast TAT were unanimously reported as benefits, and low test capacity with a single SS2R system as drawback. CONCLUSION SS2R testing for respiratory viruses offers a rapid and reliable diagnostic method which has great potential for more efficient and targeted management in adult patients with RTI.
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Affiliation(s)
- L M Vos
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Vos LM, Kammeraad JAE, Freund MW, Blank AC, Breur JMPJ. Response to letter to the editor from F. Jacques et al. Europace 2018; 20:1227. [DOI: 10.1093/europace/eux239] [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: 11/14/2022] Open
Affiliation(s)
- Laura M Vos
- Division of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, EA, Utrecht, The Netherlands
| | - Janneke A E Kammeraad
- Department of Paediatric Cardiology, Sophia Children's Hospital, Erasmus Medical Centre, Wytemaweg 80, CN, Rotterdam, The Netherlands
| | - Matthias W Freund
- Division of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, EA, Utrecht, The Netherlands
| | - Andreas C Blank
- Division of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, EA, Utrecht, The Netherlands
| | - Johannes M P J Breur
- Division of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, EA, Utrecht, The Netherlands
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10
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Vos LM, Kammeraad JAE, Freund MW, Blank AC, Breur JMPJ. Long-term outcome of transvenous pacemaker implantation in infants: a retrospective cohort study. Europace 2017; 19:581-587. [PMID: 28431056 DOI: 10.1093/europace/euw031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 02/02/2016] [Indexed: 11/14/2022] Open
Abstract
AIM Evaluation of long-term outcome of transvenous pacemaker (PM) implantation in infants. METHODS AND RESULTS A retrospective analysis of all transvenous PM implantations in infants <10 kg between September 1997 and October 2001 was made. Indications for PM implantation, age at implantation, and determinants of long-term outcome including cardiac function, PM function, and PM (system) complications were noted. Seven patients underwent transvenous VVI(R) PM implantation. Median age at implantation was 3 days (range: 1 day to 14 months), median weight 3.5 kg (range: 2.3-8.7 kg), and median follow-up 14 years (range: 12.3-16.3 years). Pacemaker indications were congenital complete atrioventricular block (n = 4), long QT syndrome with heart block (n = 2), and post-operative complete atrioventricular block with sinus node dysfunction (n = 1). No procedural complications were noted. Today all patients are alive and symptom free with good PM and cardiac function. Two patients underwent PM generator relocation for imminent skin necrosis and skin traction. Two patients suffered from asymptomatic left subclavian vein occlusion and developed thrombosis on the PM electrode. Three patients were converted to an epicardial PM system, due to atrial perforation after upgrading procedure (n = 1), syncope with need for implantable cardioverter defibrillator implantation (n = 1), and systolic dysfunction with development of dilated cardiomyopathy, which normalized under cardiac resynchronization therapy pacing (n = 1). Two patients needed atrioventricular (AV) valve repair for severe insufficiency. Two patients underwent repositioning of dysfunctional PM leads. In five patients, transvenous leads were removed. Indications were elective lead replacement (n = 1), atrial perforation (n = 1), and switch to an epicardial system (n = 3). CONCLUSION Transvenous PM implantation in infants (<10 kg) is associated with a high incidence of vascular occlusion, thrombosis, and severe atrioventricular valve regurgitation during long-term follow-up. We advocate an epicardial approach for PM implantation in small children.
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Affiliation(s)
- Laura M Vos
- Division of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Janneke A E Kammeraad
- Department of Paediatric Cardiology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Matthias W Freund
- Division of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Andreas C Blank
- Division of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Johannes M P J Breur
- Division of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
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Vos LM, Schutgens REG, de Valk HW, Spiering W, Bemelmans RHH. A patient with severe haemophilia A and multiple arterial thromboses caused by large vessel vasculitis: a case report. Haemophilia 2015; 22:e39-42. [PMID: 26572080 DOI: 10.1111/hae.12787] [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] [Accepted: 07/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- L M Vos
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R E G Schutgens
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H W de Valk
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R H H Bemelmans
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Vos LM, Morand PC, Biau D, Archambeau D, Eyrolle LJ, Loubinoux J, Perut V, Leclerc P, Arends JE, Anract P, Salmon D. High Frequency of Polymicrobial Infections After Surgical Resection of Malignant Bone and Soft Tissue Tumors: A Retrospective Cohort Study. Infect Dis Ther 2015; 4:307-19. [PMID: 26334238 PMCID: PMC4575296 DOI: 10.1007/s40121-015-0078-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Indexed: 12/15/2022] Open
Abstract
Introduction Surgical resection of a malignant bone tumor (BT) or soft tissue tumor (STT), with or without prosthetic replacement, carries a high risk of developing postoperative infections. There is limited knowledge on the bacteriological spectrum of these postsurgical infections that necessitate empirical antibiotic therapy. The aim of this study was to analyze the incidence and microbiological features of site infections following BT or STT resection. Methods In this retrospective mono-center study, we analyzed the surgical and bacteriological data of all consecutive patients who developed an infection after surgical resection of a BT or STT between January 2010 and April 2014. Results Seventy-two consecutive patients who developed an infection on the site of surgical treatment for a BT (n = 42) or SST (n = 30) were included. Polymicrobism was frequently observed, more often associated with STTs (93%) than BTs (71%; P = 0.03). Gram-negative bacteria were more frequently isolated in STTs (55%) than in BTs (26%; P = 0.01) and non-prosthesis-associated infections (54%) than prosthesis-associated infections (29%; P = 0.04), whereas staphylococci were more frequently found in BTs (76%) than in STTs (52%; P = 0.03). Overall, we found gram negatives in 82% of early acute infections, 11% of chronic infections and 7% of late acute infections (P < 0.01). Conclusion Postoperative infections in patients after surgical resection of BTs or STTs were often polymicrobial, especially following STTs. Causative bacteria were often gram negatives in STTs and non-prosthesis-associated infections, whereas staphylococci were predominant in BTs. Based on these findings, we recommend antibiotic coverage of both gram-positive and -negative bacteria with a combination of broad-spectrum antibiotics in STTs and antistaphylococcal antibiotics as first-line therapy in infections following BT surgery.
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Affiliation(s)
- Laura M Vos
- Infectious and Tropical Medicine, Internal Medicine Department, Cochin Hospital APHP, Paris, France.,Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Philippe C Morand
- Bacteriology Department, Cochin Hospital APHP, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - David Biau
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Orthopedic Surgery Department, Cochin Hospital APHP, Paris, France
| | - Denis Archambeau
- Department of Anesthesiology, Cochin Hospital APHP, Paris, France
| | - Luc-Jean Eyrolle
- Department of Anesthesiology, Cochin Hospital APHP, Paris, France
| | - Julien Loubinoux
- Bacteriology Department, Cochin Hospital APHP, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Valerie Perut
- Department of Public Health, Cochin Hospital APHP, Paris, France
| | - Philippe Leclerc
- Orthopedic Surgery Department, Cochin Hospital APHP, Paris, France
| | - Joop E Arends
- Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Philippe Anract
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France. .,Orthopedic Department, Cochin Hospital APHP, Paris Descartes University, Paris, France.
| | - Dominique Salmon
- Infectious and Tropical Medicine, Internal Medicine Department, Cochin Hospital APHP, Paris, France. .,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
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Abstract
The aim of this study was to compare the effectiveness of dexamethasone administration following arthrocentesis of the temporomandibular joint (TMJ) with a placebo (saline). Twenty-eight participants with TMJ arthralgia were randomly assigned to two groups of a parallel double-blind RCT. In both groups, an arthrocentesis procedure was carried out. In one group, the procedure was followed by the administration of a single-dose intra-articular dexamethasone. In the other group, saline was administered as a control. Follow-up visits were scheduled after 1, 3, and 24 weeks. During each visit, TMJ pain (on a 100-mm VAS) and jaw stiffness (mouth opening in mm) were scored. In the statistical analysis, generalized estimating equation (GEE) models showed no differences between the two study groups, although pain and jaw stiffness were both reduced over 24 weeks. In conclusion, intra-articular dexamethasone following arthrocentesis did not improve the procedure's effect in patients presenting with TMJ arthralgia (ClinicalTrials.gov number CT01275014).
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Affiliation(s)
- J J R Huddleston Slater
- University of Groningen, Department of Oral Health Care and Clinical Epidemiology, Centre for Dentistry and Oral Hygiene University Medical Centre Groningen, Groningen, The Netherlands.
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Wentink M, Jakimowicz JJ, Vos LM, Meijer DW, Wieringa PA. Quantitative evaluation of three advanced laparoscopic viewing technologies: a stereo endoscope, an image projection display, and a TFT display. Surg Endosc 2002; 16:1237-41. [PMID: 11984691 DOI: 10.1007/s00464-001-9127-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2001] [Accepted: 12/20/2001] [Indexed: 01/12/2023]
Abstract
BACKGROUND Compared to open surgery, minimally invasive surgery (MIS) relies heavily on advanced technology, such as endoscopic viewing systems and innovative instruments. The aim of the study was to objectively compare three technologically advanced laparoscopic viewing systems with the standard viewing system currently used in most Dutch hospitals. METHODS We evaluated the following advanced laparoscopic viewing systems: a Thin Film Transistor (TFT) display, a stereo endoscope, and an image projection display. The standard viewing system was comprised of a monocular endoscope and a high-resolution monitor. Task completion time served as the measure of performance. Eight surgeons with laparoscopic experience participated in the experiment. RESULTS The average task time was significantly greater (p <0.05) with the stereo viewing system than with the standard viewing system. The average task times with the TFT display and the image projection display did not differ significantly from the standard viewing system. CONCLUSION Although the stereo viewing system promises improved depth perception and the TFT and image projection displays are supposed to improve hand-eye coordination, none of these systems provided better task performance than the standard viewing system in this pelvi-trainer experiment.
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Affiliation(s)
- M Wentink
- OCP-Man Machine Systems, Delft University of Technology, Mekelweg 2, 2628CD, Delft, The Netherlands.
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