Author Archives: Master Theses UMCG

Tandartsbezoek en de oudere patiënt






People are getting older. Healthy aging and longer living at home is the objective in healthcare and politics. This study looked at the rapidly growing group of independently living elderly people and the factors that affect their dental visit. A ques… Continue reading

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The impact of different nCRT schedules on localization of tumor recurrences in esophageal cancer patients






Background: Identification of a different distribution and pattern of recurrent disease in
esophageal cancer (EC) patients is important for a better understanding of tumor biology and the
effect of neoadjuvant chemoradiotherapy (nCRT). This study asse… Continue reading






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Development of Participation Scale addressing participation restrictions in children who suffered from Buruli Ulcer in Benin and Ghana






Introduction: Buruli Ulcer (BU) is a debilitating skin disease caused by Mycobacterium ulcerans and when left untreated often results in scarring and retraction of the area and can lead to permanent disability.
Objectives: To develop an adequate questionnaire assessing possible participation restrictions in former BU patients younger than 15 years old in Benin and Ghana.
Methods: The research is divided into phases. Phase I consists of item collection by means interviews and observation, item selection and item reduction corresponding with the International Classification of Functioning, Disability and Health ICF domains. Phase II consists of a pilot study aiming to test the comprehensibility, feasibility, relevance and acceptability of the draft questionnaire 58 participants in Benin. Phase III consists of testing content validity, reactivity and discrimination of the new developed scale by means of appropriate statistical methods among 109 participants in Ghana.
Results: In Phase I a draft questionnaire was developed with 25 questions. Testing in Phase II resulted in the elimination of 16 of the 25 questions. The 7 questions, with an internal consistency, Cronbach’s alpha of .539 were used for further testing Phase III. 73 (63%) participants score 0 on the Participation Scale. The mean of participants scoring > 0 is 7.772 and the median 5.00 with highest possible total score on the P-scale being 35. Gender is an independent factor, with females having higher outcomes.
Conclusion: A measure is developed to determine participation restrictions in former BU below 15 years. It is the first time to establish that this group of patients face participation restrictions. Further research is required to determine cut-off score, enhancing the questionnaire validity and reliability. Moreover research is to determine the adequate methods and programmes to reduce participation restrictions in this patient group. Continue reading






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De werkenemer als boormachine? : Stage wetenschap ethiek, bedrijfsgeneeskunde en Quantified Self






This is a qualitative research on the responsibilities for health and health promotion in the workplace, from the perspective of new technologies like wearables and Quantified Self. This research is divided into two parts; the first part being a literature study, the second part consists of interviews with occupational physicians (OP’s). 7 OP’s were interviewed, and these interviews were coded and analyzed with use of ATLAS.ti.
Both the literature study and the interviews show that it is not possible to hold one party responsible for health in the workplace. The employee can be held responsible for his own health to a great extent. Nevertheless, bad health can also be a result of socioeconomic status, bad luck or lack of rational action, and the individual cannot be held accountable for those factors. A number of OP’s explained this individual responsibility of the employee with comparing them to a machine. This machine metaphor can be traced back to the 18th century tradition of materialism in medicine.
Another part of the responsibility for health in the workplace lies with the employer. He could be held responsible for creating an healthy workplace and facilitate the options for the employee to make the right health choices. The OP’s could be responsible for guiding both parties, and giving them the right medical information and background. This task will be increasingly important with the rise of new technological interventions and eHealth. Through activity trackers like pedometers this type of eHealth can be applied in the workplace. Activity trackers are a rapidly developing branch of corporate wellness, which has yet to gain evidence of its health effect. These technological applications are intertwined with our everyday lives and can have an effect on health behavior with merely being there – both in the workplace and beyond. OP’s stated that they were interested in using these technologies in their daily practice, as long as there is enough evidence for their health effect. The question is whether these developments fit in the tradition of evidence based medicine, because they are integrated with many more aspects of daily life. That is why these developments require a more culture-analytic and interdisciplinary approach.
As a result of the above mentioned technologies and pressure from the government to keep costs of healthcare as low as possible, there is a shift towards preventive medicine. This research shows that if the OP’s want to keep on track with these developments, their profile might be in need of a reassessment. There is a need for a holistic view on health in the workplace, with an emphasis on continuity of healthcare, integration of new technologies and cooperation with doctors from the curative field of healthcare. Continue reading






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Influence of deep brain stimulation of the subthalamic nucleus on cognitivesymptoms in a rat model of Parkinson’s Disease






Morbus Parkinson is a common neurodegenerative disease. It is best known for its cardinal
motor symptoms caused by loss of dopamine, which can be alleviated by dopaminergic
medication and deep brain stimulation (DBS) of the subthalamic nucleus (STN). But most
patients also have non-motor symptoms. Attention deficit and impulsivity are among the
commonest. There are indications that STN DBS affects these cognitive symptoms.
Nevertheless, there is a lack of properly controlled studies, not confounded by varying
influences. Therefor a study was performed to test attention and impulsivity in a rat model of
parkinson’s, as well as the effect of STN DBS, thereof.
A 3-class auditory oddball paradigm was used to test rats’ ability to quickly, and specifically
react to a correct tone, but to ignore a standard and distractor tone. Our results show reduced
attention and impulsivity in the 6-OHDA lesioned rat Parkinson’s model, but that STN DBS
has no effect on these symptoms. Reduced attention has been shown in Parkinson before,
while the impact of this disorder on impulsivity is less clear. This paradigm may therefore be
useful to characterize the pathophysiological mechanisms leading to disturbed attention in
Parkinson in more detail. Continue reading






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Vragen naar het vraaggedrag van patiënten: een kwalitatief onderzoek naar de ervaringen van patiënten en de rol van sociale verwachtingen bij het stellen van vragen tijdens een medisch consult






Vanuit de maatschappij wordt van patiënten verwacht dat ze zelf verantwoordelijkheid nemen voor hun eigen gezondheid en zorg (Raad voor Volksgezondheid en Zorg, 2012; Rijksinstituut voor Volksgezondheid en Milieu, 2014). Om eigen regie te voeren is het nodig om actief op te treden en mondig te zijn in de gezondheidzorg. Toch is het niet vanzelfsprekend dat iedere patiënt in staat is om mondig te zijn en vragen stelt aan een arts. In opdracht van het Universitair Medisch Centrum Groningen is dit onderzoek uitgevoerd met als doel inzicht te krijgen in de ervaringen van patiënten bij het stellen van vragen aan een arts tijdens een medisch consult. Daarbij is onderzocht in hoeverre verwachtingen vanuit de sociale omgeving, de maatschappij en vanuit artsen invloed hebben op het stellen van vragen door patiënten tijdens een medisch consult.
De Theory of Planned Behavior is gebruikt om te achterhalen wat het vraaggedrag van patiënten kan verklaren. Uit de literatuur komt naar voren dat er vrijwel niets bekend is over patiëntervaringen waar sociale verwachtingen een invloed spelen rondom het vraaggedrag van patiënten. Om die reden is explorerend onderzoek uitgevoerd aan de hand van de kwalitatieve onderzoeksbenadering van Hennink, Hutter en Bailey (2011). Interviews zijn gehouden met tien patiënten die voor een eerste consult op de afdeling Orthopedie kwamen. Met behulp van een interviewschema zijn de patiënten geïnterviewd. Deze interviews zijn vervolgens geanalyseerd met het programma ATLAS.ti
Sommige patiënten voelden zich niet gehinderd bij het stellen van vragen, maar bij sommigen leek dat wel het geval. Dat waren met name oudere patiënten, wat te maken kan hebben met het vroegere heersende idee ‘doctor knows best’ waarbij het niet gebruikelijk was om vragen te stellen aan de arts. De voorbereiding lijkt van belang te zijn voor het vraaggedrag van patiënten. De ene patiënt bereidt vragen voor en de ander doet dit niet. Dit heeft te maken met de hoeveelheid ervaring patiënten hebben opgedaan met arts-patiënt gesprekken, met eerdere klachten en door het praten met andere mensen, maar ook met het vertrouwen in de arts en het karakter van de patiënt. Toch hoeft de manier van voorbereiding niet altijd uit te maken, want ook opspelende emoties van de patiënt en de informatieverstrekking van de arts lijken het vraaggedrag van patiënten altijd te kunnen beïnvloeden.
Sociale verwachtingen lijken in meer en mindere mate het vraaggedrag van patiënten te beïnvloeden. De mate van invloed door de directe sociale omgeving, de maatschappij en vanuit artsen op het vraaggedrag van patiënten verschilt. Zo blijkt dat de directe sociale omgeving invloed kan uitoefenen op patiënten bij het bedenken en stellen van vragen tijdens een medisch consult. Patiënten vergaren informatie door met anderen binnen het sociale netwerk te praten en gebruiken deze informatie als input voor de vragen die ze bedenken om de arts te stellen. Enkele geïnterviewde patiënten stellen vragen, omdat dit van personen uit hun directe sociale omgeving moet. Minder duidelijk is de invloed vanuit de maatschappij en vanuit artsen op het vraaggedrag. Sommige patiënten gebruiken het internet als informatiebron voor het bedenken van vragen. Daarnaast lijken de geïnterviewde patiënten tegenwoordig anders aan te kijken tegen het stellen van vragen aan een arts dan dat zij vroeger deden. Patiënten lijken te weten dat de arts van hen verwacht dat ze alle informatie moeten geven aan de arts en de arts vragen moet stellen als ze informatie niet begrijpen. Geen van de geïnterviewde patiënten stelt vragen, omdat zij het idee hebben dat de maatschappij, de overheid of artsen dit van hen verwachten. Als patiënten vragen willen stellen, stellen ze deze omdat ze dit over het algemeen zelf willen en laten ze zich niet beïnvloeden door sociale verwachtingen. Continue reading






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EXPLORATIEF ONDERZOEK NAAR DE MOGELIJK MODERERENDE BIJDRAGEN VAN DOPAMINERGE EN SEROTONERGE POLYMORFISMEN AAN HET EFFECT VAN NASAAL TOEGEDIENDE OXYTOCINE OP DE SOCIALE ORIËNTATIE RESPONSES BIJ JONGE MANNEN MET EEN AUTISME SPECTRUM STOORNIS






Doel: In dit onderzoek werd gekeken naar de invloeden van enkele dopaminerge en serotonerge polymorfismen op de elektrofysiologische responses op empathie oproepende afbeeldingen en hun invloed op de effecten van intranasaal toegediende oxytocine op deze responses bij normaal intelligente volwassen mannen met en zonder een autisme spectrum stoornis (ASS).
Methode: Het betreft een gerandomiseerde dubbelblind placebogecontroleerd crossover onderzoek bij gezonde mannen en mannen met ASS. Om te beginnen moesten de deelnemers een aantal vragenlijsten invullen. Uit het bloed zijn de dopaminerge en serotonerge polymorfismen (DAT1, DRD2, DRD4, DRD5, COMT, DBH, MAO-A en 5HTTLPR) bepaald. Vervolgens kreeg de onderzoekspopulatie een placebo of oxytocine (OXT) toegediend voordat ze empathie oproepende afbeeldingen kregen te zien. De afbeeldingen zijn afkomstig van het “International Affective Picture system”(IAPs). Hierbij kregen de deelnemers afbeeldingen te zien met evenveel plezierige als onaangename en neutrale afbeeldingen met en zonder mensen. Terwijl de afbeeldingen werden bekeken, werd er met behulp van een EEG de event-gerelateerde Long Latency Parietal Positivity (LPP) gemeten.
Resultaten: De dragers van het A1-allel van het DRD2-gen lijken een geringer sociale oriëntatie respons te hebben. Dit geldt ook voor de homozygote dragers van het 4-repeat allel van het DRD4-gen en de dragers van het A1-allel van het DBH-gen. Verder lijken in de controlegroep de homozygote dragers van het 3-repeat allel van het MAO-A-gen een groter elektrofysiologische respons te hebben op de aversieve afbeeldingen. Dit geldt ook voor de dragers van het S-allel van het 5-HTTLPR-gen in de controlegroep. Daarnaast leek bij de dragers van het A1-allel van het DRD2-gen de ASS-groep meer baat te hebben bij het toedienen van OXT dan de controlegroep. Dit geldt ook voor de homozygote dragers van het 4-repeat allel in de ASS-groep van het MAO-A-gen. De homozygote dragers van het La-allel van het 5-HTTLPR-gen leken in de ASS-groep ook meer baat te hebben bij OXT toediening dan de homozygote dragers van het S-allel. Er lijkt dus sprake te zijn van een aan de klinische status differentieel gerelateerde respons.
Conclusie: De polymorfismen van het DRD2-, DRD4-, DBH-, MAO-A- en het 5-HTTLPR lijken dus invloed te hebben op de sociale oriëntatie respons op empathie oproepende afbeeldingen. Daarnaast lijkt de klinische status invloed te hebben op de manier waarop de verschillende polymorfismen het effect van OXT op de LPP-respons modereren (DRD2, MAO-A en 5-HTTLPR). Continue reading






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Master Theses UMCG 2017-03-15 11:15:31






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Pulmonary involvement in primary Sjögren’s syndrome






Background: In previous studies in primary Sjögren’s syndrome (pSS), the prevalence of
pulmonary involvement varied greatly depending on differences in inclusion criteria and
definitions of pulmonary involvement. The ESSDAI has been developed for standardized
assessment of the main organ involvements. Our aim was to evaluate the prevalence and types
of pulmonary involvement in pSS patients and to classify the manifestations using the
pulmonary domain of the ESSDAI.
Methods: This retrospective cohort study included all consecutive pSS patients, fulfilling the
AECG and/or ACR classification criteria, who visited the department of Rheumatology and
Clinical Immunology of the UMCG in 2015. Data were obtained from electronic patient records
of the first visit in 2015. In some cases, the difference between pulmonary manifestations
caused by pSS or coincidental factors remained unclear, resulting in a range of assumed to
possible pulmonary involvement in pSS.
Results: Of the 262 included pSS patients, 93% were female and mean age was 56 ± 15 years.
Pulmonary complaints were present in 88 (34%) patients. Additional pulmonary diagnostics
was performed in 225 (86%) patients. Pulmonary involvement was present in 25-39 (10-15%)
pSS patients. Overall, most common was interstitial lung disease (ILD), which was present in
15 patients; especially non-specific interstitial pneumonia (NSIP). In total, 16 (6%) patients had
a positive ESSDAI for the pulmonary domain; low activity (n=4), moderate activity (n=11) and
high activity (n=1).
Conclusion: In this cross-sectional study in daily clinical practice, pulmonary involvement was
present in 10-15% of pSS patients, most common ILD. Of all pSS patients, 6% were scored as
active on the pulmonary domain of the ESSDAI. Continue reading






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Protective Effects of Pharmacological TPRM2 Inhibition on Ischemia-reperfusion Injury of the liver






IBsachckemgrioa-urnepde rfusion injury (IRI) of the liver is a common clinical problem after liver surgery
and transplantation and new therapies are required to prevent it. Calcium overload in
hepatocytes plays a central role in the pathogenesis of IR… Continue reading






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Connective Fields (CF) in de vroege visuele cortex bij patienten met een psychotische aandoening






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The concept of micro-merging within professional services: a case study in the dutch healthcare industry






Although the literature on mergers and acquisitions (M&As) is quite advanced, analyses of micro-mergers—mergers of internal functional units within the same organization—remain limited. Clarification is needed regarding micro-mergers and their effects on performance. Therefore, this case study investigated micro-mergers within professional service firms (PSFs), specifically focusing on healthcare providers. Thereby, this study addresses the following research question: How do different types of micro-mergers affect the performance of PSFs?
Thus, it examined the various types of micro-mergers and the relationship between the type of micro-merger and PSF performance. In addition, it focused on the factors moderating the relationship between the type of micro-merger and PSF performance.
This study analyzed data on three cases within University Medical Center Groningen (UMCG). Twenty-one semi-structured interviews provided the bulk of this data. The results demonstrated that Napier’s (1989) typology of mergers also applies to micro-mergers, since all three types of micro-mergers (extension, collaborative, and redesign) were identifiable.
None of these micro-merger types led to a decline in the PSF’s performance. The collaborative and redesign micro-mergers led to an increase in the PSF’s performance. Furthermore, the results indicated that merging syndrome moderates the relationship between the type of micro-merger and PSF performance. Moreover, two factors affect the severity of the merging syndrome: equivalency and feelings of unity (social identity).
Regarding future research, researchers should explore whether these results hold true for other micro-mergers. Furthermore, the conceptual framework proposed should be further explored in a quantitative matter by measuring PSF performance. Regarding managerial implications, management should be aware that governance has significant effect on the micro-merging process. Thereby, communication is key to reduce uncertainty and stress, so as to create high levels of trust. Continue reading






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Connective Fields (CF) in de vroege visuele cortex bij paconnectiviteit in de visuele cortex, tussen enerzijds 11 patiënten met een psychotische connectiviteit in de visuele cortex, tussen enerzijds 11 patiënten met een psychotische connectiviteit in de v






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“Risk of hemorrhage after Gamma Knife radiosurgery versus natural history for hemorrhage in brain arteriovenous malformations: a retrospective descriptive study






Background: Gamma Knife Radiosurgery (GKRS) is frequently used for the treatment of brain arteriovenous malformations (BAVM). Patients with unruptured BAVM have a risk of 2.2% per year for intracranial hemorrhage with severe morbidity and mortality[16]. Patients with ruptured BAVM have 4.5% risk for a second haemorrhage[13]. Adverse radiation effects (ARE’s) are seen post treatment with variable incidence (1.8-22.9%)[39]. The latency period post GKRS is a crucial time frame for hemorrhage and ARE’s to occur. Timely follow-up and treatment are essential during this period.
Objective: The purpose of this report was to evaluate the risk of hemorrhage post GKRS for unruptured BAVM versus the natural history, in order to conclude that treatment in unruptured BAVMs with GKRS is a good approach in preventing hemorrhages. Secondly the goal was to evaluate the risk of a second hemorrhage post GKRS in ruptured BAVM versus the rebleeding risk. The incidence of ARE’s were evaluated to analyse the safety of GKRS treatment. Lastly, to evaluate the effect of treatment, obliteration rates for hemorrhage and non-hemorrhage BAVM were analysed.
Methods: The investigation was carried through a retrospective descriptive study of patients with BAVM who underwent GKRS between 2002 and 2015 at the Gamma Knife Center of the Elisabeth-Tweesteden hospital in Tilburg, the Netherlands. Patients were included based on the inclusion criteria ( age > 18 years, angiographically established BAVM and with a minimal follow-up of ≥ 3 years). Univariate and multivariate analyses were performed. The Chi square test was used to calculate the significance level (p Continue reading






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De relatie tussen de neonatale cerebrale oxygenatie en de vroeg neonatale neurologische uitkomst bij kinderen met ductusafhankelijke congenitale hartafwijkingen






Introductie: Ongeveer vijf tot elf per 1,000 levende pasgeborenen komen ter wereld met een congenitale hartafwijking (CHD). Dankzij verbeterde zorg bereikt tegenwoordig ongeveer 85% van deze kinderen de volwassen leeftijd. Kinderen met CHD hebben echter een hoger risico op neurologische ontwikkelingsstoornissen als gevolg van een complexe interactie tussen pre-operatieve, intra-operatieve en postoperatieve gebeurtenissen. Mogelijk ontstaat hersenschade ten gevolge van chronische foetale en vroeg neonatale hypoxie of ischemie van het brein. Een niet-invasieve en continue manier om de saturatie in het hersenweefsel te meten is door middel van near-infrared spectroscopy (NIRS). Neurologische uitkomst kan voorspeld worden door de beoordeling van general movements (GMs). Dit zijn spontane bewegingen die door het hele lichaam gemaakt worden en zeer voorspellend zijn voor latere neurologische uitkomst. In dit onderzoek wordt een correlatie gezocht tussen de kwaliteit van GMs op een leeftijd van 7 dagen en de cerebrale oxygenatie tijdens de eerste zeven dagen postnataal bij kinderen met CHD.
Methode: Kinderen met een antenataal bekende ductusafhankelijke CHD werden geïncludeerd en bij hen werd vervolgens gedurende de eerste zeven dagen de cerebrale oxygenatie door middel van NIRS gemeten. Op een leeftijd van 7 dagen werden de general movements gefilmd en vervolgens geanalyseerd.
Resultaten: Achttien kinderen in het Universitair Medisch Centrum Groningen (UMCG) werden geïncludeerd, waarvan er tien afwijkende GMs lieten zien. Er was geen relatie tussen de GMs bij zeven dagen en de cerebrale zuurstofsturatie in de eerste zeven dagen, ook niet na correctie voor de leeftijd waarop gefilmd werd.
Discussie: In een vervolgstudie zouden meer kinderen geïncludeerd moeten worden om de resultaten sterker te maken, daarnaast zouden kinderen ook bij drie maanden nog gefilmd moeten worden voor GMs, omdat dit een duidelijkere voorspeller is voor latere neurologische uitkomst. Continue reading






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Liver transplantation for cirrhosis secondary to non-alcoholic steatohepatitis is not performed at the expense of major postoperative morbidity






Background: Non-alcoholic steatohepatitis (NASH) is an emerging indication for liver transplantation due to the obesity pandemic. NASH frequently coexists with multiple comorbidities such as type 2 diabetes mellitus (T2DM), cardiovascular disease and the metabolic syndrome(MetS). Recent studies have shown that long-term patient and graft survival of patients transplanted for NASH cirrhosis are comparable to other indications. However, limited data exists about the short-term (procedure- related) complications after transplantation. Therefore, our aim was to investigate whether these patients are at an increased risk of short-term complications following transplantation.
Methods: This is a single centre retrospective cohort study including all adult patients (≥18 years) who underwent liver transplantation between January 2009 and December 2015 (N=224). Exclusion criteria were liver transplantation for acute hepatic failure or non-cirrhotic liver disease. Patients were censored at time of re-transplantation (n=17). Post-operative complications within 90 days were classified according to the Clavien-Dindo classification of surgical complications. NASH was defined by either: 1) histologic evidence of NASH on biopsy or explant; 2) imaging showing hepatic steatosis; 3) a phenotypic diagnosis consisting of BMI ≥ 30 kg/m2 and presence of T2DM (by either HbA1c ≥ 47 mmol/L or glucose lowering medication use) or the presence of at least 3 out of 5 diagnostic criteria for MetS as defined by the NCEP Adult Treatment Panel (ATP III). A p Continue reading






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Terminal cancer and suicide in older people; clinical characteristics and motives






Background: Terminally ill people represent a unique group where suicide may be considered as a rational and ethical act. Given their limited life expectancy and wish to reduce suffering, terminally ill people may exert their self-determination and autonomy by ending their life. Objectives: The aims of this study are to [i.] compare the socio-demographic and clinical variables of two groups of older people who completed suicide: those with advanced cancer and those without; and [ii] examine qualitatively whether the advanced cancer cases could be defined as rational suicide.
Methods: The New Zealand Coronial Services provided records of all suicide cases aged 65 years and over (n=225) between July 2007 and December 2012. We were able to determine whether there was an advanced cancer in 214 cases.
Findings: 23 (10.7%) older people who completed suicide were diagnosed with an advanced cancer. Bivariate analysis found that they were more likely to be male (91.3% versus 72.3%, p=0.048), married or in a defacto relationship (78.3% versus 46.1%, p=0.014); but less likely to have a diagnosis of depression (8.7% versus 46.6%, p=0.001), previous contact with psychiatric services (4.5% versus 35.0%, p=0.004) and past suicide attempt (9.1% versus 28.8%, p=0.048). Next to that the circumstances of 82.6 % of the advanced cancer patients who died by suicide were conceived as ‘understandable for uninvolved observers’.
Conclusions: With a growing elderly population and higher rates of suicide within the elderly, late-life suicide is becoming more prevalent. The diagnosis of terminal illness is higher amongst elderly. Further research is needed to delineate motives and suicide risks for terminally ill patients. More knowledge and understanding can offer the patient more targeted care and an earlier/better relieve of their mental and physical suffering. Continue reading






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Renal function more than twenty years after cisplatin-based chemotherapy fortesticular cancer






Background
The introduction of platinum-based chemotherapy for treatment of metastatic testicular cancer in the late 1970s has led to an increase in survival rates and a growing cohort of testicular cancer survivors. Consequently, attention for long-t… Continue reading






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Titration of oxygen therapy in critically ill emergency department patients: a feasibility study






Introduction- Oxygen is one of the most widely used drugs and is applied across the wide range of specialities. Liberal use of oxygen to reassure oxygen delivery has become standard treatment in resuscitation: in the ambulance, the emergency department (ED) and the intensive care unit (ICU). Today, most health care professionals do not adjust the amount of oxygen given when patients reach a saturation of 100% or a PaO2 which exceeds the normal range, resulting in hyperoxia. Because oxygen is a vital element, toxicity is not immediately obvious, but there is increasing evidence for the toxic effects of hyperoxia. Because of these potential harmful effects of hyperoxia it seems justified to aim for normoxia when giving oxygen therapy. Objective- This study aims to evaluate whether it is feasible to aim for normoxia when giving oxygen therapy to critically ill patients at the ED. Material and methods- This study was a prospective cohort study and was performed at the ED of the University Medical Center Groningen (UMCG). A protocol was developed, aiming for normoxia: PaO2 9,5-13,5 kPa or a corresponding oxygen saturation 94-98%. Hyperoxia was defined as PaO2 > 13.5 kPa or SaO2 > 98%, and hypoxia as PaO2 18 years admitted to the ED that were registered for cardiology, internal medicine, emergency medicine and pulmonology requiring oxygen therapy (according to the judgement of the ambulance nurse, ED nurse or ED physician) were included. Results- During the study period the protocol was followed and normoxia was obtained in 140 of the 162 study patients (86%). Patients in which the protocol was not successful were mostly severe COPD (GOLD III/IV) patients (P Continue reading






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Novel insights into pure and mixed clear cell carcinomas in endometrial cancer






background
Endometrial clear cell carcinoma (CCC) and mixed endometrioid carcinoma with a clear
cell component (EEC-CC) are rare forms of endometrial carcinoma (EC). Traditionally,
these tumors are classified and treated as high grade tumors. However, just a few studies
have identified clinical outcome for patients with pure CCCs and little is known
about the overall survival of the mixed carcinomas. Also, the predictive value of pipelle
in subtyping these tumors has not yet been determined. Lastly, determining an immunoprofile
of these tumors could bring new insights in the pathogenesis of these tumors
and be of potential diagnostic aid.
methods
We selected and revised 51 pure CCCs and 28 mixed EEC-CC cases diagnosed since 1980
in the UMCG and Isala Zwolle. Clinical outcome of these patients were compared to each
other. We also selected these patients for determining the positive predictive value of
pipelle compared to the definitive diagnosis on hysterectomy. Immunohistochemical
staining for ER, PR, PTEN, p53, HNF1-β, Napsin A, AMACR, p16 and MMR, which are
common markers used for CCC and endometrioid carcinoma, were performed on all
pure CCC and both components of the mixed carcinomas to obtain an immunoprofile of
these tumors.
results
We found an overall 5-year survival rate of 64% for CCC, compared to 68% for mixed
EEC-CC, which was not statistically significant. The positive predictive value of pipelle
for detecting a pure CCC is 100%, compared to 50% for a mixed EEC-CCC.
We found the immunophenotype of ER– and PR– (71.8-95.2% resp. 87.5-92.9%),
HNF1-β+ (61.9-91.7%) to be most common in all pure CCC cases. Loss of PTEN expression,
a p53 mutation and positive Napsin A was present in about 50% of all CCC and
AMACR immunoreactivity was present in 33%. For mixed carcinomas ER, PR and HNF1-
β expression significantly differed in expression between the endometrioid and clear
cell component. The clear cell component of the mixed tumor did show a significant
lower expression for HNF1-β and Napsin A compared to a pure CCC. Microsatellite instability
for MSH2/MSH6 was also significantly higher for mixed carcinomas compared to
pure CCC.
conclusion
The outcome of mixed carcinoma is not significantly different from a pure CCC, despite
the presence of a low-grade endometrioid component. Also, pipelle is highly predictive
for detecting a pure CCC, while correctly diagnosing just half of all mixed carcinomas.
An immunoprofile of loss of ER, PR and positive HNF1-β was most common in CCC of
our study. Furthermore, the immunoprofile of the CC component in mixed EEC-CC is
intermediate between pure CCC and EEC, suggesting a common pre-existing endometrioid
lesion from which the clear cell component originates. Continue reading






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