H.A.M. Neumann

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Finding infant rib fractures was for many years an almost undisputed proof that physical child abuse took place. Yet, these rib fractures are virtually always occult and asymptomatic and are only identified when looked for, usually with X-rays, from physical child abuse accusations related to, e.g., suspicion of the shaken baby syndrome. In a recen...

Child abuse is a dangerous situation for an infant. Professionals need to weigh the risk of failing to act when children are seriously harmed against the serious harm done by carrying out safeguarding interventions. In severe cases, foster care might be advisable. The negative effects for the child’s psychosocial development requires that such plac...

A newborn girl had, from two weeks on, small bruises on varying body locations, but not on her chest. Her Armenian grandmother easily bruised, too. Her mother was diagnosed with hypermobility-type Ehlers-Danlos-Syndrome (hEDS), an autosomal dominant connective tissue disorder, with a 50% inheritance probability. Referral to a University Medical Cen...

Pulsed dye laser (PDL) therapy can be effective in treating psoriasis, with a long duration of remission. Although PDL therapy, albeit on a modest scale, is being used for decades now, the underlying mechanisms responsible for the long‐term remission of psoriasis remain poorly understood. The selective and rapid absorption of energy by the blood ca...

Patient: Male, 1-year-old Final Diagnosis: Healthy Symptoms: None Medication:— Clinical Procedure: Foster care Specialty: Pediatrics and Neonatology Objective Rare disease Background The commercial software for hospitals, Weight Velocity for Age Standard Deviation Score (SDSWVA), claims to document the growth and development of children, although...

Background: A Venous Leg Ulcer (VLU) has a significant negative impact on quality of life. Prevention for a VLU is not yet imbedded in clinical practice because risk factors for developing a first VLU are not well-known. Objectives: The objective was to further explore the progression of Chronic Venous Disease (CVD) into a first VLU from a patie...

Objective: The risk factors obesity and reduced mobility are not well known in the development of a Venous Leg Ulcer (VLU). The aim of this scoping review is to explore the mechanisms by which obesity and reduced mobility contribute the development of a VLU in patients with Chronic Venous Disease (CVD). Methods: For this scoping review a search...

Abnormal growth of infants may indicate disease of the children, thus methods to identify growth disorders are wanted in medicine. We previously showed that two-time-points weight growth velocities at age t, calculated by a commercial software product as [Weight(t) - Weight(t - X)]/X, with X = 448 days, were erroneous due to the long separation of...

Venous Leg Ulcers (VLU) occur in about 1% of the Western population. A VLU takes three to twelve months to heal, it recurs often, and it has a negative impact on the quality of life. The risk factors for the development of a first VLU are not well‐understood and prevention of a first VLU therefore remains underappreciated. The aim of this study is...

Commercial software package “Growth Analyser Viewer Edition” (“GAVE”) aims to document, monitor and analyze growth and development in children and adolescents. Although its clinical and scientific use is widespread, there are no published studies that describe the method and its validation. We were informed that GAVE calculates the weight velocity...

Patient: Male, 0–2 Final Diagnosis: Cow milk allergy Symptoms: Obstipation • airway infections Medication: — Clinical Procedure: Elementary feeding Specialty: Pediatrics Objective Rare disease Background Pediatric condition falsification (PCF) is a rare form of child abuse in which a caregiver fabricates or induces illness in the child. The diagn...

Background and Objectives A 36‐year‐old woman underwent CO2 laser resurfacing for periocular rhytides using protective stainless steel Cox II ocular shields. Immediately after the treatment, corneal lesions were seen in both eyes. The left eye subsequent developed corneal ulceration and scarring, a deformed iris, cataract, and lower eye lashes show...

Jan Jacques Michiels,1–3 Wim Moosdorff,1 Mildred U Lao,1 Hanny Maasland,1 Janneke Maria Michiels,2,4 HA Martino Neumann,5 Petr Dulicek,6 Viera Stvrtinova,3,7 Pavel Poredos,3,8 Jacques Barth,1,3 Gualtiero Palareti,3,9 1Primary Care Medicine Medical Diagnostic Center, Rotterdam, 2Goodheart Institute, Blood Coagulation and Vascular Medicine Science Ce...

The differential diagnosis of a leg ulcer is broad with a great variety of diseases. Beside the well known as venous, arterial, mixed and diabetic most are rare. Prolidase deficiency is one of the rare causes.Nether the less it is an excellent suggestion to add also genetic diseases as prolidae deficiency to this Guideline. The committee will take...

Objective Medical compression stockings are a standard, non-invasive treatment option for all venous and lymphatic diseases. The aim of this consensus document is to provide up-to-date recommendations and evidence grading on the indications for treatment, based on evidence accumulated during the past decade, under the auspices of the International...

BACKGROUND: The success of Mohs micrographic surgery (MMS) depends partly on the correct diagnosis of slides. OBJECTIVES: To determine reliability of diagnosis from Mohs slides. METHODS: This was a prospective study evaluating the reliability of diagnosis from Mohs slides of basal cell carcinoma (BCC) presence, BCC location on the slide and BCC...

Background: Success of Mohs micrographic surgery (MMS) partly depends on correct diagnosis of slides. Objective: To determine reliability of Mohs slides diagnosis. Methods: Prospective study evaluating the reliability of Mohs slides diagnosis on basal cell carcinoma (BCC) presence, BCC location on the slide and BCC subtype among six raters who...

The classification of medical elastic compression stockings (MECS) according to pressure classes varies from country to country and neither provides any information on the elastic property nor on the ambulatory interface pressure profiles of the different products. Beside elasticity, MECS are also characterized by other properties such as stiffness...

Background: Fumaric acid esters (FAEs) are increasingly used as a systemic treatment for psoriasis, but there are still uncertainties on their suitability. Objectives: to assess the evidence on efficacy and safety of FAEs in psoriasis treatment. Methods: A systematic literature search in 7 databases up to August, 17(th) 2015. Inclusion criteri...

Fumarates or fumaric acid esters derivates (FAED) have appeared to be effective and less toxic than other systemic treatments for psoriasis. Due to its safe adverse event profile, FAED can be used as a long-term maintenance therapy. One of the greatest reasons why FAED are not preferred as a first-line treatment is that according to the recommended...

Background: Fumaric acid esters (FAEs), an oral immunomodulating treatment for psoriasis and multiple sclerosis, have been anecdotally associated with proximal renal tubular dysfunction due to a drug-induced Fanconi syndrome. Few data are available on clinical outcomes of FAE-induced Fanconi syndrome. Methods: Descriptive case series with two ca...

This is the first randomised study comparing long-Term outcomes of three different techniques for the treatment of patients with great saphenous vein (GSV) reflux: conventional surgery (CS), endovenous laser ablation (EVLA) and ultrasound-guided foam sclerotherapy (ESCT). CS and EVLA were more effective than UGFS in arresting GSV reflux 5 years aft...

There are different techniques of hair transplantation. The most common and known hair transplantation methods are the 'strip' method, where a strip of skin containing hair follicles is removed, cut into grafts and implanted in the recipient area, and the follicle unit extraction (FUE) method, in which whole follicle units are extracted one by one...

We read with interest the article by Roozeboom et al. on the comparison of 5% imiquimod and MAL-photo dynamic treatment (PDT) using a light dose of 37.5J/cm^2 of 636nm light for the treatment of superficial basal cell carcinomas (sBCC). The used data was acquired during a study comparing the mentioned low fluence PDT, 5% imiquimod and 5% fluorourac...

A variety of techniques exist for the treatment of patients with great saphenous vein (GSV) varicosities. Few data exist on the long-term outcomes of these interventions. Patients undergoing conventional surgery, endovenous laser ablation (EVLA) and ultrasound-guided foam sclerotherapy (UGFS) for GSV varicose veins were followed up for 5 years. Pri...

The Lymphoedema Quality-of-Life Questionnaire is a validated disease-specific instrument to measure the impact of lymphoedema on patients' lives. In this study, we tested its psychometric properties and validated the use of the questionnaire in its Dutch translation. We obtained the answers to a standardised questionnaire, including Lymphoedema Qua...

Fluorescence measurements in the skin are very much affected by absorption and scattering but existing methods to correct for this are not applicable to superficial skin measurements. The first use of multiple-diameter single fiber reflectance (MDSFR) and single fiber fluorescence (SFF) spectroscopy in human skin was investigated. MDSFR spectroscop...

To understand the challenges of patients with lymphedema it is important to describe functioning and to measure the effectiveness of treatment in changing functioning. The International Classification of Functioning, Disability and Health (ICF) offers an international framework to classify functioning of persons in their personal environment. ICF C...

One significant risk factor for recurrence after Mohs surgery is misinterpretation of slides. To determine how often pathologists detected incompletely excised basal cell carcinoma (BCC) on Mohs slides and to determine risk factors for incompletely excised BCCs. This retrospective study included 1,653 BCCs treated with Mohs surgery in a University...

The classification of medical elastic compression stockings (MECS) according to pressure classes varies from country to country and neither provides any information on the elastic property nor on the ambulatory interface pressure profiles of the different products. Beside elasticity, MECS are also characterized by other properties such as stiffness...

Background: To describe functioning and health of lymphedema patients and to identify their most common problems using the International Classification of Functioning, Disability and Health (ICF) as part of the preparatory studies for the development of ICF Core Sets for lymphedema. Methods: Cross-sectional study in a population of lymphedema pa...

Background The aim was to compare endovenous laser ablation (EVLA) and endovenous steam ablation (EVSA) for great saphenous varicose veins in a non-inferiority study.Methods Patients with primary great saphenous vein reflux were randomized to EVLA (940 nm) or EVSA (SVS™). Primary outcomes were treatment success (vein obliteration) at 52 weeks, and...

Background Fumaric acid esters (FAE) are considered an effective and safe long-term treatment for psoriasis. However, 30-40% of patients need to discontinue FAE treatment due to intolerable adverse events.Objectives To assess whether the addition of cetirizine, an oral histamine-1 receptor antagonist, to FAE would reduce the incidence of adverse ev...

Importance Sagging eyelids, or dermatochalasis, are a frequent concern in older adults. It is considered a feature of skin aging, but risk factors other than aging are largely unknown.Objective To study nongenetic and genetic risk factors for sagging eyelids.Design Upper eyelid sagging was graded in 4 categories of severity using digital photogr...

Compression therapy is still the cornerstone in the treatment of PTS. The therapy is primarily focused on the decrease of the AVP, enhancement of the microcirculation and reduction of the edema. In our practice, most patients are initially treated with short stretch bandage to reduce the edema. Medical Elastic Compression Stockings (MECS) class II...

Objective Phlebectomy of varicose tributaries is usually considered an additional treatment after or during saphenous ablation. As phlebectomies alone affect the hemodynamics of the venous system, this treatment can be effective as primary intervention in selected patients. The objective of this study was to analyze hemodynamic, clinical, and patie...

Different distributions of hexyl-aminolevulinate (HAL), aminolevulinic acid (ALA) and methyl-aminolevulinate (MAL) in the superficial vasculature are not well studied but they are hypothesised to play an important role in topical photodynamic therapy (PDT). The colocalisation of fluorescent CD31 and protoporphyrin IX (PpIX) was calculated using con...

Deep vein thrombosis (DVT) has an annual incidence of 0.2% in the urban population. First episodes of calf vein thrombosis (CVT) and proximal DVT are frequently elicited by risk factors, including varicose veins, cancer, pregnancy/postpartum, oral contraceptives below the age of 50 years, immobility or surgery. Leg pain and tenderness in the calf a...

Physicists and medical doctors "speak" different languages. Endovenous laser ablation (EVLA) is a good example in which technology is essential to guide the doctor to the final result: optimal treatment. However, for the doctor, it is by far insufficient just to turn on the knobs of the laser. He should understand what is going on in the varicose v...

Background: This article is the second arising from a literature review conducted as part of the development process for International Classification of Functioning, Disability and Health (ICF) Core Sets for lymphoedema. In the first article, meaningful concepts in lymphoedema-specific questionnaires were explored. Aim: To compare and analyse categ...

Endovenous laser ablation (EVLA) is a commonly used and very effective minimally invasive therapy to manage leg varicosities. Yet, and despite a clinical history of 16 years, no international consensus on a best treatment protocol has been reached so far. Evidence presented in this paper supports the opinion that insufficient knowledge of the under...

Light fractionation with a 2-h dark interval increases the efficacy of topical aminolevulinic acid (ALA) photodynamic therapy (PDT). Hexyl-aminolevulinate (HAL) is the hexyl ester of ALA. Both HAL and ALA lead to protoporphyrin IX (PpIX) accumulation in endothelial cells and to vascular effects, which are important for light fractionation. We inves...

Hair transplantation techniques have changed in the last decades. Partial longitudinal follicular unit transplantation is a new hair transplantation technique, which differs from all other hair transplantation techniques by the size of the graft and therefore much more vulnerable grafts compared to the conventional hair transplantation grafts. In t...

Endovenous laser treatment (ELT) has evolved into a frequently employed modality for the treatment of leg varicose veins. Due to the very high complete response rates, minimal complications and side effects, and the possibility to monitor therapeutic outcome noninvasively by duplex ultrasound, a considerable amount of reports have been published on...

Minimally invasive treatment of varicose veins by endovenous laser ablation (EVLA) becomes more and more popular. However, despite significant research efforts performed during the last years, there is still a lack of agreement regarding EVLA mechanisms and therapeutic strategies. The aim of this article is to address some of these controversies by...

Endovenous laser ablation (EVLA) is successfully used to treat varicose veins. However, the exact working mechanism is still not fully identified and the clinical procedure is not yet standardized. Mathematical modeling of EVLA could strongly improve our understanding of the influence of the various EVLA processes. The aim of this study is to combi...

It is known that the incidence of skin cancer is rising rapidly worldwide, but no reliable figures on multiple nonmelanoma skin cancer (NMSC) are available. To determine the actual incidence of skin cancer in dermatology practice and to estimate how this relates to the first primary tumours (registered at the Eindhoven Cancer Registry). We examined...

Aim: To get insight into the frequency of venous leg ulceration in the Dutch dermato-logic practice, and into how this profession treats this disease. Design: Material and Methods: An e-survey was conducted. To all Dutch dermatologists and residents dermatology an email was sent with an online link to a questionnaire on venous leg ulcers. Results:...

Introduction: In general, four particular causes of recalcitrant venous leg ulcers may be distinguished. These are foot pump insufficiency, chronic venous compartment syndrome and non-re-canalized popliteal vein thrombosis. The fourth cause of recalcitrant venous leg ulcers is lipodermatosclerosis as a symptom of severe chronic venous insufficiency...

Vascular responses to photodynamic therapy (PDT) may influence the availability of oxygen during PDT and the extent of tumor destruction after PDT. However, for topical PDT vascular effects are largely unknown. Arteriole and venule diameters were measured before and after hexylaminolevulinate (HAL) and aminolevulinic acid (ALA) PDT and related to t...

Psoriasis vulgaris is a T-cell mediated disease that affects 2-3% of the worldwide white-skinned population. Fumaric acid esters are mentioned as an effective therapy for moderate-to-severe psoriasis vulgaris in adult patients in the new guidelines for psoriasis treatment. To obtain an insight into the use of fumaric acid esters by Dutch dermatolog...

Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia with characteristic clinical pattern of progressive frontotemporal hairline recession, perifollicular erythema and hyperkeratosis and symptoms of itch and burning, occurring mainly in post-menopausal women. FFA is considered a subtype of lichen planopilaris (LPP), based...

In many western countries endovenous thermal ablation techniques have largely replaced classical surgery for the treatment of saphenous varicose veins as they are more effective and patient friendly. Because these treatments can be performed under local tumescent anaesthesia, patients can mobilize immediately after the procedure. A new method of th...

Purpose: To identify and quantify the meaningful concepts within questionnaires focusing on lymphedema using the International Classification of Functioning, Disability and Health (ICF). Methods: Electronic searches of Medline, EMBASE, CINAHL, CENtral and Pedro (2005-2010) were conducted. The concepts in the questionnaires were retrieved from th...

Purpose: To identify and quantify the meaningful concepts within questionnaires focusing on lymphedema using the International Classification of Functioning, Disability and Health (ICF). Methods: Electronic searches of Medline, EMBASE, CINAHL, CENtral and Pedro (2005–2010) were conducted. The concepts in the questionnaires were retrieved from the i...

Eighty percent of non-melanoma skin cancers are located in the head and neck area. Mohs micrographic surgery (MMS) is a highly effective treatment for tumors with unfavorable characteristics. There are many closure techniques available to close a Mohs defect. The medical records of all patients diagnosed with nonmelanoma skin cancers of the head an...

The objective of this paper is to answer the clinical question whether the location of the lesion in an individual patient with actinic keratosis (AK) influences the absolute risk of the development of skin cancer. Between 0.025% and 16% of AK lesions advance towards squamous cell carcinoma per year. It is not well known whether this risk differs b...

Background In the Netherlands basal cell carcinomas (BCC) are eligible for Mohs microscopic surgery (MMS) if certain criteria are fulfilled. Objective To study the MMS indication criteria practised at the department of dermatology of the Erasmus University Medical Center, Rotterdam and to identify predictive factors for extensive subclinical tumour...

Photodynamic therapy (PDT) using topical porphyrin-precursors is a promising treatment for superficial basal cell carcinoma (sBCC), but it needs further optimization. The aim of this study was to compare 5-year lesion (complete) response rates of sBCC treated with topical aminolaevulinic acid (ALA)-PDT using a single illumination vs. ALA-PDT using...

Background Patients with melanoma are at increased risk of developing a subsequent melanoma. Objectives To estimate the risks of developing a second primary in situ or invasive cutaneous melanoma after a first melanoma, between 1989 and 2008. Methods Patients were followed until diagnosis of a second melanoma, date of death or end of study. Cumulat...

The incidence of anal intraepithelial neoplasia (AIN) and anal cancer is increased in HIV-positive men who have sex with men (MSM). Persistent high-risk human papillomavirus (HPV) infection is an important etiologic agent. In this study, a group of 250 HIV-positive MSM was included to determine the prevalence of AIN and to investigate the role of h...

EVLA has proven to be very successful, but the optimum methods for energy delivery have still not been clarified. A better understanding of the mechanism of action may contribute to achieving a consensus on the best laser method and the most effective use of laser parameters, resulting in optimal clinical outcomes, maintaining high success rates wi...

Background: Actinic keratoses (AK) are premalignant lesions occurring mainly in sun-damaged skin. Current topical treatment options for AK and photo-damaged skin such as liquid nitrogen and electrosurgery are not suitable for field treatment. Otherwise, therapies suitable for field treatment bring along considerable patient discomfort. Non-ablative...

Previous research on fluorescence detection of non-melanoma had mixed results. An accurate non-invasive method for the detection of skin cancer is valuable to dermatologists because of the high incidence of skin cancer among the aging population. One notable difference between the methods of fluorescence detection previously studied was the use of...

Imiquimod 5% cream can reduce or clear superficial and small nodular basal cell carcinoma (BCC). It could be used as a pretreatment of Mohs micrographic surgery (MMS) to decrease defect size. To study if a pretreatment with imiquimod 5% cream decreases defect size after MMS. In addition, to study the effect on the number of Mohs stages and reconstr...

The skin-blanching assay is used for the determination and bioequivalence of dermatologic glucocorticoids (GCs). The exact mechanism of the production of blanching is not fully understood, but it is considered that local vasoconstriction of the skin microvasculature and the consequent blood-flow reduction cause this phenomenon. Several factors infl...

The hallmark of chronic venous insufficiency is venous hypertension. Long term venous insufficiency can result in a chronic compartment syndrome. The gold standard investigation to measure venous hypertension is an ambulatory venous pressure measurement. However, this investigation as well as the compartment pressure measurement (in patients with a...

Mohs' micrographic surgery is the best treatment for (recurrent) basal cell carcinoma with an aggressive histological subtype in the H-zone of the face. There are more (potentially) aggressive cutaneous tumors where micrographic control of all margins is preferred. To improve care for skin cancer patients, boundaries are pushed and indications for...

Objective: This study aims to compare the anatomical success, complications and quality of life after three different treatments for saphenous varicose veins after one year follow-up. Methods: 240 consecutive patients with primary symptomatic great saphenous vein reflux were randomized to endovenous laser ablation (EVLA), ultrasound-guided foam scl...

Reflux cannot be interpreted without knowledge of the function of the calf muscle pump. The presence or absence of reflux alone has an insufficient predictive value for excellent functional treatment results. Valves are not simple moving slips but have an autonomous 4-step cycle movement that helps the calf muscle pump to be very effective. New cal...

Skin, veins and legs are the three ingredients which compose together the symptom complex know as chronic venous insufficiency (CVI). High ambulatory venous pressure is transferred by simple physical laws to the skin microcirculation. The capillaries are not resistant to this high pressure and will leak water, erythrocytes and plasma proteins into...

Background Follow-up of melanoma patients has been a continuing issue for discussion in the past years partly due to ever increasing incidence of this disease, as well as the lack of agreement regarding the reasons for, and the frequency of follow-up. Patients’ perspectives are often not included in this continuing discussion on follow-up of melano...

Increased ambulatory venous pressure is the key feature of chronic venous insufficiency, and causes capillary leakage and venous edema. This capillary leakage can be measured with plethysmography and is called the capillary filtration rate (CFR). Reduction of the CFR leads to less edema formation and improves the healing of venous ulcers. Aim: To s...

The number of skin cancer patients, especially patients with basal cell carcinoma (BCC), is rapidly increasing. Resources available at dermato-oncology units have not increased proportionally, which affects the throughput time of patients. To assess the feasibility and safety of implementation of the one-stop-shop concept for the treatment of patie...