Carine van der Vleuten

Carine van der Vleuten
Radboud University | RU · Department of Dermatology

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Introduction
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Publications

Publications (86)
Article
Background and purpose: Sturge-Weber syndrome (SWS) is a neurocutaneous disorder characterized by clinical manifestations involving the brain, eye and skin. SWS is commonly caused by somatic mutations in G protein subunit Alpha Q (GNAQ). Five cases of subunit Alpha 11 (GNA11) mutations have been reported. We studied phenotypic features of GNA11-SW...
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Background: A comprehensive lymphatic system is indispensable for a well-functioning body: it is integral to the immune system and is also interrelated with the digestive system and fluid homeostasis. The main difficulty in examining the lymphatic system is its fine-meshed structure. This remains a challenge, leaving patients with uninterpreted sy...
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The European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN), is dedicated to gathering the best expertise in Europe and provide accessible cross-border healthcare to patients with rare vascular diseases. Infantile Hemangiomas (IH) are benign vascular tumors of infancy that rapidly growth in the first weeks of life, followed by...
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The central lymphatic system consists of the thoracic duct, cisterna chyli and the retroperitoneal lymphatics through which lymph and chyle flows. Disorders of the central lymphatic system can for instance lead to leakage (chylothorax), accumulation of fluid (lymphedema) and retrograde flow (protein losing enteropathy). Abnormalities in the central...
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Introduction: Patients with congenital vascular malformations often suffer from an impaired quality of life (QoL) because of pain and functional disabilities. Previous studies have shown that the mTOR inhibitor sirolimus can reduce complaints and improve QoL in some patients. High target levels of sirolimus of 10-15 ng/ml were well tolerated; howe...
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This retrospective study examines the outcomes of sclerotherapy in children with (veno)lymphatic malformations who received sclerotherapy between 2011 and 2016 (116 children, 234 procedures). Complication severity was classified using the Society of Interventional Radiology classification. Clinical response was rated on a scale of 0 (no change) to...
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Purpose: To evaluate treatment outcomes of embolization for peripheral arteriovenous malformations (AVMs) in a tertiary referral center where ethanol is the primary agent of choice. Methods: A retrospective study was performed of 93 patients (median age, 31 years; range, 2-66 years) with peripheral AVMs treated with embolization (n = 442; median...
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Vascular malformations are part of overgrowth syndromes characterized by somatic mosaic mutations or rarely by germline mutations. Due to their similarities and diversity, clinicopathological classification can be challenging. A comprehensive targeted Next Generation Sequencing screen using Unique Molecular Identifiers (UMI's) with a technical sens...
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Introduction: In the work-up of patients with suspected pelvic congestion syndrome, venography is currently the gold standard. Yet if non-invasive diagnostic tools are found to be accurate, invasive venography might no longer be indicated as necessary. Material and methods: A literature search in Pubmed and EMBASE was performed from inception un...
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Background: In shared decision-making, clinicians and patients arrive at a joint treatment decision, by incorporating best available evidence and the patients' personal values and preferences. Little is known about the role of shared decision-making in managing patients with congenital vascular malformations, for which preference-sensitive decisio...
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Introduction Low-flow vascular malformations are congenital abnormalities of the veins, capillaries or lymphatic vessels or a combination of the previous. Compressive garments are frequently used as a first-line treatment option for low-flow vascular malformations of the extremities with the purpose of relieving symptoms. Yet, the benefits and harm...
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Blue Rubber Bleb Nevus syndrome (Bean syndrome, BRBN) is a rare, severe disorder of unknown cause, characterized by numerous cutaneous and internal venous malformations (VMs); gastrointestinal lesions are pathognomonic. We discovered somatic mutations in TEK, the gene encoding TIE2, in 15 of 17 individuals with BRBN. Somatic mutations were also ide...
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Bathing assistance is a core element of essential care in nursing homes, yet little is known for quality of assisted bathing or its determinants. AIM:To explore differences in completeness of assisted bathing in relation to bathing method and resident characteristics. METHODS: Secondary analysis of a cluster randomised trial including 500 nursing...
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Congenital vascular abnormalities like infantile hemangiomas and other vascular anomalies are a special group of disorders in neonates. Differential diagnosis, treatment and patient care require specific expertise in order to prevent complications, to reassure or inform the parents and more over to avoid unnecessary interventions. Knowledge about g...
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Background No-rinse disposable wash gloves are increasingly implemented in health care to replace traditional soap and water bed baths without proper evaluation of (cost) effectiveness. Objectives To compare bed baths for effects on skin integrity and resistance against bathing and costs. Design Cluster randomized trial Setting 56 nursing home w...
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Bij een prematuur geboren meisje ontstonden rond dag tien post partum multipele cutane hemangiomen (figuur 1). Het neonatale beloop was tot dan toe ongecompliceerd.
Article
Infantile hemangiomas are the most common benign tumors of childhood. Most infantile hemangiomas are characterized by spontaneous involution and do not require further investigation or treatment. However, flat segmental hemangiomas (i.e. large hemangiomes with a circumscript pattern localized in the lumbosacral or perineal area or in the face) are...
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In 2008 beta blockers were reported to be successful in the treatment of severe infantile hemangiomas. Topical beta blockers, like timolol eye drops (0,5[%] twice a day 1-2 drops), have beneficial effects as well. Timolol is a non-selective betablocker used in ophthalmology for the treatment of glaucoma in adults and children since 1978. Timolol ap...
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Two patients with a large port-wine stain on the scalp are discussed. A six-month old girl was born with a progressive multifocal capillary malformation. Due to a family history with intracerebral aneurysms, the diagnosis hereditary hemorrhagic telangiectasia was considered. A two-year old girl presented with congenital erythema at the scalp, arm a...
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Propranolol has revolutionized the therapy and expanded the therapeutic options for infantile hemangiomas. Despite years of experience in the treatment of cardiology conditions with propanolol, also in children, it is still recommended to reserve treatment for the more serious, not primarily cosmetically disturbing hemangiomas because of uncertaint...
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Objectives: Ultra sound colored duplex sonography is the preferred method in diagnosing chronic venous disease. Data in children on incidence, indications, and results are lacking. Methods: From the total of 9180 duplex investigations performed in our hospital from 2009 to 2012, data on indication and results of the investigation as well as pati...
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Because the best possible treatment for venous malformations is unclear, this study systematically reviews the available literature regarding the effectiveness of different treatment options for the patient group. Venous malformations result from incorrect development of the veins during embryogenesis and are present at birth. Venous malformations...
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Lymphedema is caused by dysfunction of lymphatic vessels, leading to disabling swelling that occurs mostly on the extremities. Lymphedema can be either primary (congenital) or secondary (acquired). Familial primary lymphedema commonly segregates in an autosomal dominant or recessive manner. It can also occur in combination with other clinical featu...
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Een veneus ulcus aan het onderbeen, of ulcus cruris venosum, dat niet geneest is een belastend probleem voor patiënt en arts. De arts vraagt zich af of de diagnose klopt, of de behandeling goed wordt uitgevoerd, en of de patiënt de behandeling lastig vol te houden vindt. Schattingen van de prevalentie van het ulcus cruris veno-sum in de algemene be...
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Objective: To assess the effect of graduated compression stockings (GCS) on lower leg volume and leg complaints in runners during and after exercise. Design: Cross-sectional study. Setting: Radboud University Nijmegen Medical Centre and an outdoor running track in Nijmegen, The Netherlands. Patients or other participants: Thirteen Dutch trai...
Article
Summary Background Infantile haemangioma (IH) is a benign, common and self-limiting tumour of infancy; only a minority of cases need active treatment. Currently, propranolol appears superior to classic treatments. Objectives To document in a prospective study indications and side-effects of propranolol for complicated IH in a large patient group. M...
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To investigate the effectiveness of the Lively Legs programme on patient adherence to compression therapy, walking behaviour and leg exercising, as well as on leg ulcer recurrence. Randomized controlled trial (ClinicalTrials.gov identifier: NCT00184873). A total of 184 patients with leg ulcers having predominantly venous aetiologies from 11 Dutch d...
Article
Infantile haemangiomas (IHs) are common, benign vascular tumours in children that appear soon after birth and regress before the age of 12 years. Physicians have always been concerned about the considerable psychosocial impact these lesions might have on children and their parents. This is the first critical review of studies on the psychosocial im...
Article
To evaluate the efficacy of embolization for treating the symptoms of pelvic congestion syndrome (PCS). Twenty-one women with PCS who were treated with embolization at Radboud University Nijmegen Medical Centre between 2003 and 2008 were sent a questionnaire about their symptoms before embolization, 2 months after the first embolization, and at the...
Article
Infantile haemangiomas (IH) are the most commonly occurring benign tumours of infancy, which may lead to considerable morbidity, such as amblyopia, ulceration and airway obstruction, depending on localization. Until recently, treatment was difficult: high-dose systemic glucocorticoids had limited effect and serious side effects. In 2008, the effect...
Article
To compare the treatment and follow-up of patients with lichen sclerosus (LS) at the departments of Gynaecology and Dermatology at the Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands, to evaluate the need for a multidisciplinary vulvar clinic. Treatment and follow-up data of all women with histologically proven (between Januar...
Article
In the spring of 2008, a group from Bordeaux, France published an accidentally found new treatment for hemangiomas with propranolol. Illustrated by a typical case, the Hecovan-group describes her experience with this new, very promising approach of hemangiomas in the growth phase. Propranolol is an old and well-known medicine that might have seriou...
Article
A patient was referred to our vulvar outpatient clinic because of a vaginal ulceration that persisted for 3 years and that had been unresponsive to any prescribed therapy. After a possible association was found with nicorandil therapy, this medication was stopped. Thereafter, the ulceration fully healed within 6 months.
Article
When in patients with leg ulcers ambulatory treatment does not lead to improvement, a hospitalisation can be considered. Confinement temporarily improves hemodynamic relations, so that wound-healing can occur. In this retrospective research the results of the hospital admissions of patients with difficult, therapy-resistant leg ulcers in the past 1...
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A 77-year-old female patient was referred to our hospital with multiple erosions on her right lower leg, which persisted after cryopeeling of actinic keratoses on both legs. The left leg healed without complications with a good cosmetic result. However, on the right lower leg a large area consisting of multiple painful erosions developed, which wer...
Article
Our purpose was to get better insight into the ulceration of hemangiomas, by comparing patient characteristics of non-ulcerated hemangiomas with hemangiomas with active or past ulceration. A retrospective analysis was performed of files of patients who visited the Radboud University Medical Centre Nijmegen (UMCN), the Netherlands, between 1997 and...
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Our purpose was to get better insight into the ulceration of hemangiomas, by comparing patient characteristics of non-ulcerated hemangiomas with hemangiomas with active or past ulceration. A retrospective analysis was performed of files of patients who visited the Radboud University Medical Centre Nijmegen (UMCN), the Netherlands, between 1997 and...
Article
Anal fissures are seen relatively frequently in men and women. Usually the healing process is spontaneous, but sometimes a visit to the doctor is necessary. The clinical feature of an anal fissure is characterized by a sharp pain during and after defecation and by loss of blood. The pain usually diminishes after a few hours. Differential diagnosis:...
Article
To assess levels of physical activity, particularly walking and leg exercises, among patients with venous leg ulcers and the extent to which patients adhere to compression therapy. Descriptive cross-sectional study. Patients from 12 outpatient dermatology clinics were invited to participate in this study. When they agreed, they were asked to wear a...
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This paper is a report of a study to identify the determinants of physical activity (PA) in patients with venous leg ulcers to develop recommendations for behavioural interventions aimed at enhancing physical activity. Physical activity promotes wound healing and prevents the recurrence of wounds in venous patients with leg ulcers. Many patients wi...
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Lichen sclerosus is a chronic disorder of skin and mucosa which affects patients of all age groups, particularly women, but also men. It is most commonly seen on the female genital skin, but it also occurs on extragenital areas. Most patients complain of itching and, less frequently, a burning sensation, dyspareunia, dysuria and painful defecation...
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Presentation of a 38-year-old male with multiple congenital superficial arteriovenous malformations of the right arm, shoulder and chest. Differential diagnostic considerations will be discussed here, but no classifying diagnosis has been found, despite broad investigation and literature study.
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The ability to predict severity of the post-thrombotic syndrome (PTS) early after acute deep-vein thrombosis (DVT) is limited. The aim of our study was to examine the incidence of PTS prospectively and to evaluate the predictive value of non-invasive venous examinations shortly after DVT for the development of PTS. In 93 patients with DVT thrombosi...
Article
Chronisch veneuze insufficiëntie is een veelvoorkomende progressieve aandoening. Belangrijke onderdelen van de behandeling van deze aandoening, met name in geval van ulcera cruris, zijn wondbehandeling en bandageren of het dragen van therapeutische elastische kousen. Inmiddels zijn er aanwijzingen dat oefentherapie als aanvullende therapie een posi...
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We describe a patient with an acquired unilateral vascular lesion. We diagnosed unilateral nevoid telangiectasia (UNT) on the basis of the clinical presentation and additional investigations. UNT is a rare disease, which can be acquired or congenital and consists of multiple telangiectasias following the Blaschko lines.
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This article explains the term sella clinic. Three painful disorders, proctalgia fugax, vulvodynia and cryptitis, are described.
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To gain insight in gait and calf muscle endurance in patients with severe chronic venous insufficiency. Fifteen patients with severe chronic venous insufficiency (healed or active ulcers) and 19 healthy controls were selected for this study. Subjects had to perform eight trials at preferred walking speed and eight trials at instructed walking speed...
Article
The aim of the current study was to investigate whether the StethoDop can serve as a valid and reproducible instrument for measuring the ankle-brachial index (ABI) and assessing venous reflux, even when used by inexperienced investigators, in comparison with the classic Doppler. I) During four weeks, four ankle-brachial index (ABI) measurements wer...
Article
We describe a patient with a complex neurocutaneous syndrome of congenital vascular malformations, abnormalities of brain and bones, and soft tissue hypertrophy of one leg. According to eponymous classification schemes, the patient can be assigned to two different clinical entities. Using the lethal gene theory it is possible to unify these differe...
Article
Clearance and relapse characteristics of clobetasol lotion under hydrocolloid occlusion once weekly versus clobetasol ointment twice daily were assessed in a comparative flow cytometric study. Quantitative analysis of markers for epidermal proliferation, differentiation and inflammation was performed on epidermal single cell suspensions prepared fr...
Article
Scalp psoriasis is a frequent expression of the common skin disease psoriasis, and scaling and itching are the two major complaints. Topical treatments are the mainstay of the treatment of psoriasis of the scalp, with the vehicle as well as the active ingredient relevant to efficacy, tolerability and compliance. Vehicles can be shampoos, lotions, g...
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It is well established that the efficacy of corticosteroids under occlusion with hydrocolloids (HCD) is superior compared to monotherapy with topical corticosteroids. However, following treatment with more potent corticosteroids, increased side effects and a more pronounced rebound might be expected. In the present clinical study, the efficacy of r...
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Tenascin-C is an extracellular matrix glycoprotein that is markedly upregulated in the dermis of psoriatic skin. In this study, we have addressed the question whether the presence of tenascin-C in the lesion or in serum is a marker for disease activity. Immunohistochemical staining of tenascin-C before and after treatment with different topical and...
Article
A parallel-group, double-blind, randomised study was performed to establish the effect of the vitamin D3 analogue KH 1060, in an ointment versus vehicle only, on the epidermal cell characteristics of chronic idiopathic lichen planus; KH 1060 also has marked immunosuppressive activity. A group of 10 patients were treated for 8 weeks with either KH 1...
Article
Lichen planus (LP) and discoid lupus erythematosus (DLE) are separate disease entities. Nevertheless, patients with a so-called "overlap syndrome" have been described occasionally. The aim of the present study was to establish whether the LE/LP overlap syndrome, based on clinical and routine histological features, could be delineated from DLE or LP...
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Tacalcitol (Curatoderm® 4 μg/g ointment, once daily) was shown to be effective and safe in the treatment of patients with chronic plaque psoriasis in a previous multicentre, placebo-controlled double-blind study. After a 4- week medication-free interval, an open-label, prospective study was started with a planned minimum duration of 12 weeks. The m...
Article
Dithranol has been used successfully in the treatment of psoriasis for more than 75 years, and much in vitro and in vivo research has been done on the elucidation of the mode of action of this potent and safe antipsoriatic therapy. In vivo research has revealed major effects of dithranol on epidermal proliferation and inflammation. Information on t...
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Micanol, in which dithranol is micro-encapsulated in crystalline monoglycerides, is easy to wash off and staining and irritation are inconspicuous. These features make it appropriate to use in an out-patient setting. In this study the immunohistochemical effects of this new dithranol formulation were studied and compared with UVB and the combinatio...
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Ultraviolet B (UVB) irradiation has extensively been advocated for use in the investigation of cutaneous inflammation in vivo. Mostly doses above the threshold of skin damage have been used. Therefore it is not clear whether the changes observed are specific effects of UVB or to a certain extent represent wound healing. In this study the dose-depen...
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Treatment of psoriasis with vitamin D3 analogues is well established in present dermatological practice. One of the clinical signs of the psoriatic plaque that reduces early and markedly during treatment with the vitamin D3 analogue calcipotriol is scaling. Since scaling is the clinical manifestation of disordered epidermal differentiation, early c...
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Corticosteroids and vitamin D3 analogues inhibit proliferation, enhance normal keratinisation and interfere with cutaneous inflammation in in vitro systems. Both treatments are effective in psoriasis, although several reports suggest that vitamin D3 is less effective in reducing the inflammatory changes compared to its potent effect on keratinocyte...
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In this case report a patient with therapeutically recalcitrant erythrodermic psoriasis is presented. After various attempts with several major therapies in this patient, the first substantial improvement was achieved using the combination of cyclosporine and calcipotriol, followed by the combination of UVB and calcipotriol. The therapeutic options...
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Twenty-seven patients with severe alopecia areata were treated with dapsone. The results of a mean treatment duration of 10 +/- 0.5 months are reported, and compared with the results of long-term topical immunotherapy obtained previously at the same institute. The efficacy of dapsone proved to be markedly inferior to that of topical immunotherapy....
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Calcipotriol (50 μg/g) ointment recently became available for the treatment of psoriasis. Calcipotriol has been shown to be superior to home treatment with dithranol. The time-honoured regime of in-patient topical treatment with dithranol in paste or petrolatum for 24 hours is the gold standard of optimal efficacy of antipsoriatic therapy. This tre...