Fred Nieman

Utrecht University, Utrecht, Utrecht, Netherlands

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Publications (134)

  • Source
    Henrica N. A. M. van Breugel · Orlando Parise · Fred H. M. Nieman · [...] · Sandro Gelsomino
    [Show abstract] [Hide abstract] ABSTRACT: Background We investigated the impact and the predictive value of sinus rhythm at 12 months (SR12) on subscales of three different HrQoL questionnaires: SF-36., EuroQoL and MFI 20. Methods Data of 125 cardiac surgery patients with pre-operative AF from our previous randomized trial were used. Based on their rhythm outcome patients were divided in two groups: SR12 or AF at 12 months follow up (non-SR12). All questionnaires were self-administered pre-operatively and at 3 months, 6 months and 12 months after surgery. Results Synus rhytm at 12 months was predictive of improvement of SF36- mental score (MS, p = 0.021), Euro-QoL-MS (p = 0.009), VAS (p = 0.006), and MFI 20-MS (p = 0.009). We failed to find any significant interactions between SR12 and any of the other significant risk factors: age <65 years, paroxysmal type of AF and preoperative AF duration <12 months. In contrast, SR12 was not significant in predicting physical score (PS) subscales of any of the questionnaires (all, p > 0.05) which were predicted by age <65 years (SF36-PS, p = 0.029) by paroxysmal type of AF and age <65 years (Euro-QoL-PS, p = 0.017 and p = 0.04, respectively) and by AF duration <12 months, paroxysmal type of AF and age < 65 years (MFI 20-PS, p = 0.019, p = 0.020 and p = 0.015, respectively). Conclusions Specific mental-related HrQoL scales are much more sensitive to sinus rhythm conversion. Sinus rithm mantainance shows significant effects on mental scores independently of other cofactors. Successful conversion to sinus rhythm after surgical ablation during cardiac surgery does not significantly affect phisical health related quality of life during 1 year follow up.
    Full-text available · Article · Dec 2016 · Journal of Cardiothoracic Surgery
  • Conference Paper · Aug 2016
  • [Show abstract] [Hide abstract] ABSTRACT: Objective: Pregnancy and delivery are the most prominent risk factors for the onset of pelvic floor injuries and - later-on - urinary incontinence. Supervised pelvic floor muscle training during and after pregnancy is proven effective for the prevention of urinary incontinence on the short term. However, only a minority of women do participate in preventive pelvic floor muscle training programs. Our aim was to analyze willingness to participate (WTP) in an intensive preventive pelvic floor muscle training (PFMT) program and influencing factors, from the perspective of postpartum women, for participation. Study design: We included 169 three-month postpartum women in a web-based survey in the Netherlands. Demographic and clinical characteristics, knowledge and experience with PFMT and preconditions for actual WTP were assessed. Main outcome measures were frequencies and percentages for categorical data. Cross tabulations were used to explore the relationship between WTP and various independent categorical variables. A linear regression analysis was done to analyze which variables are associated with WTP. Results: A response rate of 64% (n=169) was achieved. 31% of the women was WTP, 41% was hesitating, 12% already participated in PFMT and 15% was not interested (at all). No statistically significant association was found between WTP and risk or prognostic pelvic floor dysfunction factors. Women already having symptoms of pelvic floor dysfunction such as incontinence and pelvic organ prolapse symptoms were more WTP (p=0.010, p=0.001, respectively) as were women perceiving better general health (p<0.001). Preconditions for women to participate were program costs, and travel time not exceeding 15min. Conclusions: From the perspective of postpartum women, there is room for improvement of preventive pelvic floor management. Further research should focus on strategies to tackle major barriers and to introduce facilitators for postpartum women to participate in PFMT programs.
    Article · Nov 2015 · European journal of obstetrics, gynecology, and reproductive biology
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    Fabio S Catarinella · Fred H M Nieman · Cees H.A. Wittens
    [Show abstract] [Hide abstract] ABSTRACT: Background Modern medicine should no longer rely solely on technical success to evaluate treatments. The treatment of venous disease has seen many new developments, insights, and treatment modalities. Combining clinical scores with quality of life (QoL) outcome measurements is becoming the new norm for evaluation of treatments. Many different outcome assessment instruments are currently available, indicating a lack of consensus. Methods We set out to find the most reliable and comprehensive scoring instrument for clinical and QoL measurement in venous disease. In this review, we focus on the eight most widely used instruments. For clinical assessment, these are the Clinical, Etiologic, Anatomic, and Pathologic (CEAP) classification, Villalta scale, and Venous Clinical Severity Score (VCSS); for generic QoL, the 36-Item Short Form Health Survey (SF-36) and EQ-5D questionnaires; and for disease-specific QoL, the Aberdeen Varicose Vein Questionnaire (AVVQ), Chronic Venous Insufficiency Questionnaire (CIVIQ), and VEnous INsufficiency Epidemiological and Economic Study on Quality of Life/Symptoms (VEINES-QOL/Sym) questionnaire. Each instrument is reviewed. Conclusions For the accurate evaluation of treatment outcomes, socioeconomic, QoL, and clinical aspects must be assessed. None of the available disease-specific instruments is suited to use in uniform outcome measurement for the whole spectrum of venous disease. A new combined QoL and clinical instrument is needed to validly assess and compare the outcomes of venous treatments. The VEINES-QOL/Sym is currently the most valid instrument to assess disease-specific QoL.
    Full-text available · Article · Jul 2015
  • Bary Berghmans · Fred Nieman · C Leue · [...] · G van Koeveringe
    [Show abstract] [Hide abstract] ABSTRACT: (i) To describe and analyse pelvic floor dysfunction symptoms in women referred to a Pelvic Care Centre (PCC). (ii) To describe the triage process of the same patients based on response to a first-contact interview. Triage started with a telephone interview using previously constructed questions, asking for seven types of PF complaints during the preceding 6 months. If present, complaint severity was registered on a 0-10 scale. Next, these first-contact complaints were used to describe patient case mix profiles using cross-tabular analysis. Later on, at first PCC visit, an intake questionnaire containing questions on specific PF health problem(s) was filled out. This procedure contributed to a firm baseline characterization of the individual patient profile and a clinically valid allocation to structured, predefined assessment, and treatment. From 2005 to 2013, 4473 first-time patients (mean age 56.9 (SD 16.2) have been referred to the PCC. Most frequently mentioned complaints: voiding dysfunction (59.5%), urinary incontinence (46.6%), prolapse (41.1%), fecal incontinence (15.1%), constipation (12.6%), and sexual problems (4.6%). A first appointment to a single specialist was determined in 3.110 (69.5%) patients, in 1.192 (26.7%) consultation of >1 specialist. Data analysis revealed higher-order interactions between PF complaints, suggesting patient profile complexity and patient population heterogeneity. More than one out of four PCC patients showed multifactorial problems, needing >1 specialist. PF complaints either turned out to stand alone or cluster with others, or even to strengthen, weaken, nullify, or inverse relationships. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    Article · Mar 2015 · Neurourology and Urodynamics
  • [Show abstract] [Hide abstract] ABSTRACT: Gesuperviseerde looptraining is de eerste keus in de conservatieve behandeling van patiënten met claudicatio intermittens. Diabetes mellitus is een vaak voorkomende comorbiditeit bij patiënten met perifeer arterieel vaatlijden (PAV). Het huidige veronderstelde werkingsmechanisme van looptraining suggereert dat looptraining leidt tot gunstige fysiologische veranderingen in de skeletspiermetabolisme en de endotheelfunctie, wat zich uit in een toename van de loopafstand.
    Article · Feb 2015
  • Bary Berghmans · Fred Nieman · C Leue · [...] · G van Koeveringe
    [Show abstract] [Hide abstract] ABSTRACT: (i) To describe and analyse pelvic floor dysfunction symptoms in men referred to a Pelvic Care Centre (PCC). (ii) To describe the triage process of the same patients based on response to a first-contact interview. Triage started with a telephone interview using previously constructed questions, asking for six types of PF complaints during the preceding 6 months. If present, complaint severity was registered on a 0-10 scale. Next, these first-contact complaints were used to describe patient case mix profiles using cross-tabular analysis. Later on, at first PCC visit, an intake questionnaire regarding specific PF health problem(s) was filled out. This procedure contributed to a firm baseline characterization of the individual patient profile and a clinically valid allocation to structured, predefined assessment and treatment. From 2005 to 2013 985 first-time patients (mean age 58.2 years (SD 15.3) have been referred to the PCC. Most frequently mentioned complaints: voiding dysfunctions (73.9%), urinary incontinence (29.5%), sexual problems (16.6%), faecal incontinence (13.9%), constipation (9.6%), and prolapse (0.3%). A first appointment to a single specialist was determined in 805 (81.7%) patients, in 137 (13.9%) consultation of >1 specialist. Data analysis revealed higher-order interactions between PF complaints, suggesting patient profile complexity and patient population heterogeneity. One out of seven PCC patients showed multifactorial problems, needing >1 specialist. PF complaints either turned out to stand alone or cluster with others, or even to strengthen, weaken, nullify or inverse relationships. Neurourol. Urodynam. 9999:1-5, 2014. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    Article · Jan 2015 · Neurourology and Urodynamics
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    [Show abstract] [Hide abstract] ABSTRACT: Hypothesis / aims of study Urinary incontinence (UI) is a widespread problem with great impact on quality of life and with high annual costs for patients and society. Pregnancy and delivery are the most prominent risk factors for the onset of pelvic floor injuries and -later-on- UI. Intensive supervised pelvic floor muscle training (PFMT) during and after pregnancy is proven effective for the prevention of UI on the short term. However, only a minority of women do participate in preventive PFMT programs. Therefore, an analysis of barriers and facilitators from the perspective of postpartum women for participation in a preventive PFMT program was performed. Study design, materials and methods A web-based survey was held in 3-months post-partum women in four regions in the Netherlands. All participating women gave their informed consent to the health professionals who approached them for the survey. To find barriers and facilitators for participation in a preventive PFMT program, postpartum women were asked for their willingness to participate (WTP) in such a preventive intensive PFMT program. To find specific factors that might be associated with prevalence of pelvic floor dysfunctions (PFDs) and the WTP, participants reported on demographic and clinical characteristics, i.e. obstetrical and urogynecological history, knowledge and experience with PFMT and preconditions for actual WTP. Frequencies and percentages are reported for categorical data. Bivariate analysis was performed in cross tabulations (with L2 statistics) to explore the relationship between WTP and various independent categorical variables. A linear regression analysis was done to analyse which variables are associated with WTP using listwise deletion of missing cases. A p-value less than 0.05 is considered statistically significant. SPSS 21 is used for data analysis. Results The web-based questionnaire was filled in by 169 adult white women (64%). The age of the majority of the women was between 25 and 34 years and 79.2% finished tertiary education. Almost half of the women had ever experienced UI and over half of them had UI during and after the last pregnancy. The large majority of all postpartum women (over 95%) want professional information on the prevention of –later onset- PFDs and acknowledge that intensive supervised preventive PFMT during and after pregnancy may be very important to prevent future pelvic floor problems. Women prefer to be informed during pregnancy (75%), either individually by a health professional (43%) or through a folder or website (43%). However, when asked for their willingness to actively participate in an intensive preventive PFMT program one out of three women reported to be willing to participate and 41% of the women reported to be in doubt, 11.9% already participates in PFMT and 15.4% is not interested (at all). No statistically significant association was found between WTP and risk and prognostic factors for PFDs (maternal age, parity, birth weight, BMI, pelvic floor injuries). Further analysis showed that women with a better general health and women with a higher UI severity sumscore and POP symptoms are statistically significantly more ‘willing to participate’ in a preventive PFMT program (p < 0.001, p = 0.010 and p = 0.001 respectively). Preconditions for those women who are willing to participate or those in doubt are program costs. Up to €100 is acceptable for the majority of these women. However, one of five of the women in doubt is not prepared to pay for a PFMT program at all. Next to this, travel time should not exceed 15 minutes. Interpretation of results It is obvious that the large majority of women who recently had a baby do want professional information on the prevention of PFDs and do acknowledge the importance of preventive PFMT during and after pregnancy. However, several barriers and facilitators for change in actual WTP in preventive PFMT from the perspective of postpartum women are found. The study results show that there is no association between the awareness of the preventive effects and the existence of PFDs, even controlled for risk and prognostic factors for PFDs. Further research should focus on solutions how to support both women and health professionals (obstetricians, midwives, family physicians, physiotherapists) to improve awareness of risk and/or prognostic factors for PFDs, to inform on the benefits of a good PFM function and to facilitate motivation of postpartum women for active participation and adherence to preventive PFMT programs (multidisciplinary supported and tailor made intensive supervised evidence based program). Next to this, taking into consideration preconditions can facilitate actual participation of postpartum women in preventive PFMT programs. Concluding message Looking at the perspective of postpartum women, there is room for quality improvement of preventive PF management. Further research should focus on solutions to tackle major barriers and to introduce facilitators for postpartum women to participate and adhere to intensive PFMT programs to prevent –later onset- PFDs. References 1. Boyle R, Hay-Smith E, Cody J, Morkved S. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews 2012, DOI: 10.1002/14651858.CD007471.pub2.; (10). 2. DeLancey JOL, Kane Low L, Miller JM, Patel DA, Tumbarello JA. Graphic integration of causal factors of pelvic floor disorders: an integrated life span model. Am J Obstet Gynecol. 2008;199(6):610.e1-.e5. 3. Buurman MBR, Lagro-Janssen ALM. Women’s perception of postpartum pelvic floor dysfunction and their help-seeking behaviour: a qualitative interview study. Scand J Caring Sci. 2013;27(2):406-13. Disclosures Funding: NA Clinical Trial: No Subjects: HUMAN Ethics not Req'd: Upon consultation, the Medical Ethics Committee of the region Maastricht, stated that ethical approval was not needed given the non-invasive character of the survey. However, all participating women gave their informed consent to the health professionals that approached them for the survey. Helsinki: Yes Informed Consent: Yes
    Full-text available · Conference Paper · Oct 2014
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    Elham Bidar · Bart Maesen · Fred Nieman · [...] · Jos G Maessen
    [Show abstract] [Hide abstract] ABSTRACT: Background Post-operative atrial fibrillation (POAF) is considered to be a transient arrhythmia in the first week after surgery. Objectives The aim of this study was to determine the 30-day incidence and predictors of POAF and the value of postoperative overdrive biatrial pacing in prevention of POAF. Methods Patients (n=148) without a history of AF undergoing aortic valve replacement (AVR) or coronary artery bypass graft (CABG) were randomized into a pacing group (n=75) and a control group. Patients were treated with standardized Sotalol post-operatively. Rhythm was continuously monitored for 30 days by a trans-telephonic event recorder. Results POAF occurred in 73 patients (49.3%) of whom 60 patients (40.5%) showed POAF during post-operative days (POD) 0-5 and 37 patients (25%) during POD 6-30. Prolonged aortic cross clamp time (ACCT) was an important univariate predictor of 30-day and of late POAF (POD 6-30) (p=0.017, p= 0.03 respectively). Best-fit model analysis using 15 predetermined risk factors for POAF showed different positive interactive effects for early POAF (i.e. baseline C-reactive protein (CRP) levels with a history of myocardial infaction (MI) or low Body mass index (BMI)) and late POAF (i.e. high BMI, diabetes mellitus, baseline CRP, early POAF, creatinine levels, type of operation, smoking and male gender). Biatrial pacing reduced the late POAF incidence in patients with ACCT > 50 minutes (p=0.006). Conclusion POAF is not limited to the first week after cardiac surgery but also occurs frequently in the post-operative month. It is desirable to regularly follow POAF patients for AF recurrences after discharge.
    Full-text available · Article · Jul 2014 · Heart rhythm: the official journal of the Heart Rhythm Society
  • [Show abstract] [Hide abstract] ABSTRACT: Congestive heart failure is frequent and leads to reduced exercise capacity, reduced quality of life (QoL), and depression in many patients. Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD) offer therapeutic options and may have an impact on QoL and depression. This study was performed to evaluate physical and mental health in patients undergoing ICD or combined CRT/ICD-implantation (CRT-D). Echocardiography, spiroergometry, and psychometric questionnaires [Beck Depression Inventory, General World Health Organization Five Well-being Index (WHO-5), Brief Symptom Inventory and 36-item Short Form (SF-36)] were obtained in 39 patients (ICD: 17, CRT-D: 22) at baseline and 6-month follow-up (FU) after device implantation. CRT-D patients had a higher NYHA class and broader left bundle branch block than ICD patients at baseline. At FU, ejection fraction (EF), peak oxygen uptake, and NYHA class improved significantly in CRT-D patients but remained unchanged in ICD patients. Patients with CRT-D implantation showed higher levels of depressive symptoms, psychological distress, and impairment in QoL at baseline and FU compared to ICD patients. These impairments remained mostly unchanged in all patients after 6 months. Overall, these findings imply that there is a need for careful assessment and treatment of psychological distress and depression in ICD and CRT-D patients in the course of device implantation as psychological burden seems to persist irrespective of physical improvement.
    Article · Jun 2013 · Heart and Vessels
  • Article · Jan 2013 · Heart and Vessels
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    [Show abstract] [Hide abstract] ABSTRACT: Primary treatment for patients with intermittent claudication is exercise therapy. Diabetes mellitus (DM) is a frequently occurring comorbidity in patients with intermittent claudication, and in these patients, exercise tolerance is decreased. However, there is little literature about the increase in walking distance after supervised exercise therapy (SET) in patients with both intermittent claudication and DM. The objective of this study was to determine the effectiveness of SET for intermittent claudication in patients with DM. Consecutive patients with intermittent claudication who started SET were included. Exclusion criteria were Rutherford stage 4 to 6 and the inability to perform the standardized treadmill test. SET was administered according to the guidelines of the Royal Dutch Society for Physiotherapy. At baseline and at 1, 3, and 6 months of follow-up, a standardized treadmill exercise test was performed. The primary outcome measurement was the absolute claudication distance (ACD). We included 775 patients, of whom 230 had DM (29.7%). At 6 months of follow-up, data of 440 patients were available. Both ACD at baseline and at 6 months of follow-up were significantly lower in patients with DM (P < 0.001). However, increase in ACD after 6 months of SET did not differ significantly (P = 0.48) between the DM group and the non-DM group (270 m and 400 m, respectively). In conclusion, SET for patients with intermittent claudication is equally effective in improving walking distance for both patients with and without DM, although ACD remains lower in patients with DM.
    Full-text available · Article · Aug 2012 · Annals of Vascular Surgery
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    [Show abstract] [Hide abstract] ABSTRACT: Scand J Caring Sci; 2013; 27; 253–259 Consumer satisfaction among patients and their general practitioners about involving nurse specialists in primary care for patients with urinary incontinence Background: Urinary incontinence (UI) is a very common problem, but existing guidelines on UI are not followed. To bring care in line with guidelines, we planned an intervention to involve nurse specialists on UI in primary care and assessed this in a randomised controlled trial. Alongside this intervention, we assessed consumer satisfaction among patients and general practitioners (GPs). Methods: Patients’ satisfaction with the care provided by either nurse specialists (intervention group) or GPs (control group), respectively, was measured with a self-completed questionnaire. GPs’ views on the involvement of nurse specialists were measured in a structured telephone interview. Results: The patient satisfaction score on the care offered by nurse specialists was 8.4 (scale 1–10), vs. 6.7 for care-as-usual by GPs. Over 85% of patients would recommend nurse specialist care to their best friends and 77% of the GPs considered the role of the nurse specialist to be beneficial, giving it a mean score of 7.2. Conclusions: Although the sample was relatively small and the stability of the results only provisionally established, substituting UI care from GP to nurse specialist appears to be welcomed by both patients and GPs. Small changes like giving additional UI-specific information and devoting more attention to UI (which had been given little attention before) would provide a simple instrument to stimulate patients to change their behaviour in the right direction.
    Full-text available · Article · May 2012 · Scandinavian Journal of Caring Sciences
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    Michiel Haeseker · Leo Stolk · Fred Nieman · [...] · Annelies Verbon
    [Show abstract] [Hide abstract] ABSTRACT: Aim: The aim of this study was to determine the ciprofloxacin serum concentrations in hospitalized patients and to determine which percentage reached the efficacy target of AUC : MIC > 125. Additionally, the influence of demographic anthropomorphic and clinical parameters on the pharmacokinetics and pharmacodynamics of ciprofloxacin were investigated. Methods: In serum of 80 hospitalized patients ciprofloxacin concentrations were measured with reverse phase high performance liquid chromatography with fluorescence detection. The ciprofloxacin dose was 400-1200 mg day(-1) i.v. in two or three doses depending on renal function and causative bacteria. Pharmacokinetic parameters were calculated with maximum a posteriori Bayesian estimation (MW\PHARM 3.60). A two compartment open model was used. Results: Mean (± SD) age was 66 (± 17) years, the mean clearance corrected for bodyweight was 0.24 l h(-1) kg(-1) and the mean AUC was 49 mg l(-1) h. Ciprofloxacin clearance and thus AUC were associated with both age and serum creatinine. Of all patients, 21% and 75% of the patients, did not reach the proposed ciprofloxacin AUC : MIC > 125 target with MICs of 0.25 and 0.5 mg l(-1), respectively. A computer simulated increase in the daily dose from 800 mg to 1200 mg, decreased these percentages to 1% and 37%, respectively. Conclusion: A substantial proportion of the hospitalized patients did not reach the target ciprofloxacin AUC : MIC and are suboptimally dosed with recommended doses. Taking into account the increasing resistance to ciprofloxacin worldwide, a ciprofloxacin dose of 1200 mg i.v. daily in patients with normal renal function is necessary to reach the targeted AUC : MIC > 125.
    Full-text available · Article · May 2012 · British Journal of Clinical Pharmacology
  • [Show abstract] [Hide abstract] ABSTRACT: Sacral neuromodulation therapy has been successfully applied in adult patients with urinary and fecal incontinence and in adults with constipation not responding to intensive conservative treatment. No data, however, are available on sacral neuromodulation therapy as a treatment option in adolescents with refractory functional constipation. This study aimed to describe the short-term results of sacral neuromodulation in adolescents with chronic functional constipation refractory to intensive conservative treatment. This is a retrospective review. This study took place at the Department of Surgery, Maastricht University Medical Centre, The Netherlands. Thirteen patients (all girls, age 10-18 years) with functional constipation according to the ROME III criteria not responding to intensive oral and rectal laxative treatment were assigned for sacral neuromodulation. When improvement of symptoms was observed during the testing phase, a permanent stimulator was implanted. Patients were prospectively followed up to at least 6 months after implantation of the permanent stimulator by interviews, bowel diaries, and Cleveland Clinic constipation score. Improvement was defined as spontaneous defecation ≥ 2 times a week. At presentation, none of the patients had spontaneous defecation or felt the urge to defecate. All patients had severe abdominal pain. Regular school absenteeism was present in 10 patients. After the testing phase, all but 2 patients had spontaneous defecation ≥ 2 times a week with a reduction in abdominal pain. After implantation, 11 (of 12) had a normal spontaneous defecation pattern of ≥ 2 times a week without medication, felt the urge to defecate, and perceived less abdominal pain without relapse of symptoms until 6 months after implantation. The average Cleveland Clinic constipation score decreased from 20.9 to 8.4. One lead revision and 2 pacemaker relocations were necessary. This study is limited by its small sample size, single-institution bias, and retrospective nature. Sacral neuromodulation appears to be a promising new treatment option in adolescents with refractory functional constipation not responding to intensive conservative therapy. Larger randomized studies with long-term follow-up are required.
    Article · Mar 2012 · Diseases of the Colon & Rectum
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    [Show abstract] [Hide abstract] ABSTRACT: Sarcoidosis is a multisystemic inflammatory granulomatous disease. The prevalence of hepatic involvement is not clear. The aim of this study was to establish the presence and severity of the liver-test abnormalities in sarcoidosis. Retrospectively, patients with confirmed sarcoidosis (n=837) presented with the liver-test abnormalities [alkaline phosphatase, γ-glutamyl transaminase, alanine aminotransferase or aspartate aminotransferase >1.5 times the upper limit of normal (ULN)] who were classified according to severity into mild (zero liver tests ≥3×ULN), moderate (one or two liver tests ≥3×ULN) and severe (three or four liver tests ≥3×ULN) were evaluated. Moreover, the relationship between severity of liver tests and histology was examined. Liver-test abnormalities were found in 204 of 837 patients with chronic sarcoidosis (24.4%), among which 127 (15.2%) were suspected of having hepatic sarcoidosis (79 of 127 males, 111 Caucasian, eight African-American). In 22 of 127 patients (17.3%), a liver biopsy was obtained; 21 were compatible with hepatic sarcoidosis. In these 21 patients, severity of liver-test abnormalities was significantly associated with extensiveness of granulomatous inflammation (ρ=0.58, P=0.006) and degree of fibrosis (ρ=0.64, P=0.002). These results remained in the multiple regression analysis when controlled for treatment status, sex, genetics, ethnicity and age. Liver-test abnormalities were present in 24% of the studied patients; in 15% highly because of hepatic involvement of sarcoidosis. Moderate and severe liver-test abnormalities seemed to be associated with more advanced histopathological disease. Therefore, in the management of sarcoidosis, for patients with moderate or severe liver-test abnormalities a liver biopsy is recommended.
    Full-text available · Article · Jan 2012 · European journal of gastroenterology & hepatology
  • [Show abstract] [Hide abstract] ABSTRACT: To compare the patient's response rate to the Percutaneous Nerve Evaluation test (PNE) and the 1st stage tined-lead placement test (FSTLP) for sacral neuromodulation therapy (SNM). Single center study on patients with refractory idiopathic overactive bladder syndrome (OAB) or non-obstructive urinary retention, screened with both PNE and FSTLP. Patients were followed prospectively and their response rate based on bladder diary after PNE was compared to that after FSTLP. More than 50% improvement in at least two relevant urinary symptoms was considered a positive response. A Wilcoxon paired test was done to compare the rates of the two screening options and logistic regression to determine possible associations. A follow-up was conducted to determine the long-term failure rate. One hundred patients were included (82 female, 69 OAB). The mean age was 55 years (SD 13). The positive response rate on PNE was 47%. FSTLP showed a 69% positive response rate, which was negatively related to age. The 22% gain in positive response was statistically significant (P < 0.001) and positively associated with female gender and younger age. All 69 patients with a positive response to FSTLP received SNM treatment. Failure rate after an average of 2 years was 2.9%. This study suggests that FSTLP may be a more sensitive screening method than PNE to identify patients eligible for SNM therapy, warranting randomized trials.
    Article · Sep 2011 · Neurourology and Urodynamics
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    Eva Rombout-Sestrienkova · Fred H.M. Nieman · Brigitte A.B. Essers · [...] · Ger H Koek
    [Show abstract] [Hide abstract] ABSTRACT: Standard treatment of newly diagnosed HFE hemochromatosis patients is phlebotomy. Erythrocytapheresis provides a new therapeutic modality that can remove up to three times more red blood cells per single procedure and could thus have a clinical and economic benefit. To compare the number of treatment procedures between erythrocytapheresis and phlebotomy needed to reach the serum ferritin (SF) target level of 50 µg/L, a two-treatment-arms, randomized trial was conducted in which 38 newly diagnosed patients homozygous for C282Y were randomly assigned in a 1:1 ratio to undergo either erythrocytapheresis or phlebotomy. A 50% decrease in the number of treatment procedures for erythrocytapheresis compared to phlebotomy was chosen as the relevant difference to detect. Univariate analysis showed a significantly lower mean number of treatment procedures in the erythrocytapheresis group (9 vs. 27; ratio, 0.33; 95% confidence interval [CI], 0.25-0.45; Mann-Whitney p < 0.001). After adjustments for the two important influential factors initial SF level and body weight, the reduction ratio was still significant (0.43; 95% CI, 0.35-0.52; p < 0.001). Cost analysis showed no significant difference in treatment costs between both procedures. The costs resulting from productivity loss were significantly lower for the erythrocytapheresis group. Erythrocytapheresis is highly effective treatment to reduce iron overload and from a societal perspective might potentially also be a cost-saving therapy.
    Full-text available · Article · Aug 2011 · Transfusion
  • Tom A T Marcelissen · Randall K Leong · Fred H M Nieman · [...] · Stefan G G de Wachter
    [Show abstract] [Hide abstract] ABSTRACT: What's known on the subject? and What does the study add? Sacral neuromodulation (SNM) is a well-established treatment for patients with chronic LUTS. The selection of eligible candidates could be improved by identifying factors that can predict a successful response. In the present study, we evaluated the role of various psychological and psychiatric factors in relation to SNM treatment. • To evaluate if psychological and psychiatric factors can predict the outcome of test stimulation or permanent treatment with sacral neuromodulation (SNM). • Between 2006 and 2009, patients with overactive bladder syndrome or non-obstructive urinary retention who were eligible for test stimulation were included. • All patients completed the Amsterdam Biographic Questionnaire (ABQ), which measures the personality traits of the patient, and the Symptom Check-List-90-Revised (SCL-90-R), which is a screening instrument for neuroticism, and for current level of complaints. • The results of the questionnaires were compared with the outcomes of test stimulation and permanent treatment. • In addition to the questionnaires, we also included the psychiatric history as a potential predictive factor. • On univariate analysis there was no relationship between the psychological characteristics and the outcome of test stimulation or the occurrence of adverse events (AEs) with permanent treatment. • A history of psychiatric disease was not related to the outcome of test stimulation, but was shown to be a positive predictor for the occurrence of AEs with permanent SNM treatment. • In the present study there was no evidence that psychological screening with the ABQ or SCL-90-R can predict the outcome of SNM treatment. • Patients with a medical history of psychiatric disease appear to be more likely to encounter AEs with permanent SNM treatment.
    Article · Aug 2011 · BJU International
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    [Show abstract] [Hide abstract] ABSTRACT: Inflammation, interstitial fibrosis (IF), and tubular atrophy (TA) precede chronic transplant dysfunction, which is a major cause of renal allograft loss. There is an association between IF/TA and loss of peritubular capillaries (PTCs) in advanced renal disease, but whether PTC loss occurs in an early stage of chronic transplant dysfunction is unknown. Here, we studied PTC number, IF/TA, inflammation, and renal function in 48 patients who underwent protocol biopsies. Compared with before transplantation, there was a statistically significant loss of PTCs by 3 months after transplantation. Fewer PTCs in the 3-month biopsy correlated with high IF/TA and inflammation scores and predicted lower renal function at 1 year. Predictors of PTC loss during the first 3 months after transplantation included donor type, rejection, donor age, and the number of PTCs at the time of implantation. In conclusion, PTC loss occurs during the first 3 months after renal transplantation, associates with increased IF and TA, and predicts reduced renal function.
    Full-text available · Article · Jun 2011 · Journal of the American Society of Nephrology