Wetenschappelijk jaaroverzicht 2016 www.catharinaziekenhuis.nl Wetenschappelijk Jaaroverzicht 2016 Onder redactie van: JMAH Jansen (Jolanda) E Looije (Ellen) Een uitgave van het Catharina Ziekenhuis Eindhoven, 2017 © niets van deze uitgave mag worden gekopieerd zonder toestemming van de uitgever. 2 Inhoudsopgave Algemeen Klinisch Laboratorium 5 Anesthesiologie 15 Apotheek 26 Cardiologie 35 Cardiothoracale Chirurgie 69 Chirurgie 73 Dermatologie 161 Diëtetiek 165 Geriatrie 168 Gynaecologie 172 Hygiëne en infectiepreventie 186 Intensive Care 188 Inwendige geneeskunde 190 Keel-, Neus- en Oorheelkunde 212 Kindergeneeskunde 214 Klinische Fysica 218 Longgeneeskunde 222 Maag, darm, leverziekten 224 Medische Psychologie 239 Mondziekten, kaak en aangezichtschirurgie 242 Neurologie 244 Nucleaire Geneeskunde 248 Onderwijs & Onderzoek 251 Operatiekamers 254 Orthopedie 257 Pamm 262 Plastische Chirurgie 267 Radiologie 271 Radiotherapie 283 Spoedeisende hulp 289 Urologie 292 Boeken 296 Promoties 301 Wetenschapsavond 2015 Catharina Ziekenhuis 305 Tabellen 336 Auteursindex 343 3 “Do not go where the path may lead, go instead where there is no path and leave a trail” Ralph Waldo Emerson (1803-1882) American poet Ralph Waldo Emerson. BrainyQuote.com. Retrieved April 4, 2017, from BrainyQuote.com Web site: https://www.brainyquote.com/quotes/authors/r/ralph_waldo_emerson.html 4 5 Algemeen Klinisch Laboratorium 6 Berkel M van (Miranda) Diagnosis of acute myocardial infarction in hemodialysis patients may be feasible by comparing variation of cardiac troponins during acute presentation to baseline variation van Berkel M*, Dekker MJ*, Bogers H*, Geerse DA*, Konings CJ*, Scharnhorst V* Clin Chim Acta. 2016 May 1;456:36-41. Epub 2016 Feb 11 Acute myocardial infarction (AMI) is defined as a dynamic change in cardiac troponin (cTn) with at least one cTn value exceeding the 99 th percentile of a reference population in combination with typical clinical symptoms. In hemodialysis (HD) patients, a broad range of cTn concentrations is found, partially due to patient-specific comorbidities. Therefore, the 99 th percentile cannot be used in HD patients and decision algorithms to diagnose AMI should be based on temporal variations of troponin. In this study, relative and absolute variations of cTn in a large population of asymptomatic hemodialysis patients were established during a period of 15 months. Patients were stratified according to their history of coronary artery disease (CAD). An intra-individual long term variation of 23% for cTroponin I (cTnI) and 12% for cTroponin T (cTnT) was found for patients without a history of CAD. The corresponding reference change values (RCVs) were 69% and 39% respectively. For patients with a history of CAD this variation was 29% for cTnI and 10% for cTnT, with RCVs of 86% and 35% respectively. During follow up, 27 HD patients developed an acute myocardial infarction (AMI). During these events, irrespective of CAD history, cTnI increased>172% and cTnT increased>97% above baseline cTn as measured during clinically stable periods three months separate to the event. Therefore, if a HD patient has symptoms of an acute event and a cTn increase that exceeds the RCVs described here, AMI may be suspected. If the troponin increase exceeds 172% for cTnI or 97% for cTnT, AMI is likely. impactfactor: 2.799 Boer AK (Arjen-Kars) Comparison Between Different Intramuscular Vitamin B12 Supplementation Regimes: a retrospective matched cohort study Smelt HJ*, Pouwels S*, Said M*, Berghuis KA*, Boer AK*, Smulders JF* Obes Surg. 2016 Dec;26(12):2873-2879 Voor abstract zie: Dietetiek - Smelt HJ impactfactor: 3.346 Boer AK (Arjen-Kars) Cut-off values to rule out urinary tract infection should be gender-specific Geerts N*, Boonen KJ, Boer AK*, Scharnhorst V* Clin Chim Acta. 2016 Jan 15;452:173-6. Epub 2015 Nov 23 Voor abstract zie: Algemeen Klinisch Laboratorium - Geerts N impactfactor: 2.799 Boer AK (Arjen-Kars) Improving Bariatric Patient Aftercare Outcome by Improved Detection of a Functional Vitamin B12 Deficiency Smelt HJ*, Smulders JF*, Said M*, Nienhuijs SW*, Boer AK* Obes Surg. 2016 Jul;26(7):1500-4. Epub 2015 Nov 4 Voor abstract zie: Dietetiek - Smelt HJ impactfactor: 3.346 7 Boer AK (Arjen-Kars) Interference of anticoagulants on coagulation testing van de Kerkhof D*, Schmitz E, Moolenaar M*, Schellings M, Boer AK*, Boonen K Clin Chem Lab Med. 2016 Jul 1;54(7):e207-10 Geen abstract beschikbaar impactfactor: 3.017 Boer AK (Arjen-Kars) Laboratoriumdiagnostiek bedraagt slechts 4% van een poliklinische internistische DOT Rietjens K, Wilbik AM, Kaymak U, Scharnhorst V*, Boer-AK* Ned Tijdschr Klin Chem Labgeneesk, 2016 ; 41(3):209-10 Geen abstract beschikbaar impactfactor: -- Deiman AL (Birgit) Reduced number of cardiovascular events and increased cost-effectiveness by genotype-guided antiplatelet therapy in patients undergoing percutaneous coronary interventions in the Netherlands Deiman BA*, Tonino PA*, Kouhestani K*, Schrover CE*, Scharnhorst V*, Dekker LR*, Pijls NH* Neth Heart J. 2016 Oct;24(10):589-99 AIM: This study explores clinical outcome in cytochrome P450 2C19 (CYP2C19)-related poor metaboliser patients treated with either clopidogrel or prasugrel after percutaneous coronary intervention (PCI) and investigates whether this could be cost-effective. METHODS AND RESULTS: This single-centre, observational study included 3260 patients scheduled for elective PCI between October 2010 and June 2013 and followed for adverse cardiovascular events until October 2014. Post PCI, CYP2C19 poor metaboliser patients were treated with clopidogrel or prasugrel, in addition to aspirin. In total, 32 poor metabolisers were treated with clopidogrel and 41 with prasugrel. The number of adverse cardiovascular events, defined as death from cardiovascular cause, myocardial infarction, stent thrombosis, every second visit to the catheterisation room for re-PCI in the same artery, or stroke, within 1.5 years of PCI, was significantly higher in the CYP2C19 poor metaboliser group treated with clopidogrel (n = 10, 31?%) compared with the poor metaboliser group treated with prasugrel (n = 2, 5?%) (p = 0.003). Costs per gained quality-adjusted life years (QALY) were estimated, showing that genotype-guided post-PCI treatment with prasugrel could be cost-effective with less than € 10,000 per gained QALY. CONCLUSION: This study provides evidence that for CYP2C19-related poor metabolisers prasugrel may be more effective than clopidogrel to prevent major adverse cardiovascular events after PCI and this approach could be cost-effective. impactfactor: 2.062 Geerts N (Nienke) Between analyser differences in chloride measurements and thus anion gap cause different interpretations of the acid-base balance Geerts N*, Wlazlo N*, Scharnhorst V* Clin Chem Lab Med. 2016 Mar;54(3):e81-4 Geen Abstract beschikbaar impactfactor: 3.017 8 Geerts N (Nienke) Cut-off values to rule out urinary tract infection should be gender-specific Geerts N*, Boonen KJ, Boer AK*, Scharnhorst V* Clin Chim Acta. 2016 Jan 15;452:173-6. Epub 2015 Nov 23 The diagnosis of urinary tract infection (UTI) by urine culture is an expensive and time- consuming procedure. Using a screening method, to identify negative samples, would improve the procedure and reduce costs. In this study, urine flow cytometry, of over 7000 urine samples, was assessed by retrospective analysis. With a cut-off value of >200bacteria/µl, we obtained a sensitivity of 93.0%, a specificity of 63.5%, and a negative predictive value (NPV) of 96.2%. As a result the culturing of 49% of all samples could be avoided. In addition, the data was retrospectively analyzed to determine if the introduction of gender-specific cut-off values could improve screening results. The obtained receiver operator curves are indeed significantly different when gender specific cut-offs were used. When a NPV of 95% is considered acceptable the unisex cut-off value of >200bacteria/µl can be used for women (NPV 94.9%), but the cut-off value for men could be raised to >400bacteria/µl without diminishing the NPV (NPV 95.0%). impactfactor: 2.799 Geerts N (Nienke) Technieken voor het uitsluiten van urineweginfecties: Labquiz Nienke Geerts en Volkher Scharnhorst Ned Tijdschr Geneeskd. 2016;160: D101Q Van alle klachten en aandoeningen waarmee vrouwen een arts consulteren, komt een urineweginfectie (UWI) het meest voor. De gouden standaard voor het aantonen van een UWI is een urinekweek. Omdat de uitslag van een urinekweek echter vaak pas na 3 dagen bekend is, zijn er andere technieken waarmee een mogelijke UWI eerder kan worden uitgesloten. Op basis van welke test mag de arts een urineweginfectie uitsluiten? impactfactor: -- Heuvel D van den (Dennis) Determination of dabigatran and rivaroxaban by ultra-performance liquid chromatography-tandem mass spectrometry and coagulation assays after major orthopaedic surgery Schellings MW, Boonen K, Schmitz EM, Jonkers F*, van den Heuvel DJ*, Besselaar A*, Hendriks JG, van de Kerkhof D Thromb Res. 2016 Mar;139:128-34. Epub 2016 Jan 18 Voor abstract zie: Orthopedie - Jonkers F impactfactor: 2.320 Kerkhof D van de (Daan) Determination of dabigatran and rivaroxaban by ultra-performance liquid chromatography-tandem mass spectrometry and coagulation assays after major orthopaedic surgery Schellings MW, Boonen K, Schmitz EM, Jonkers F*, van den Heuvel DJ*, Besselaar A*, Hendriks JG, van de Kerkhof D* Thromb Res. 2016 Mar;139:128-34. Epub 2016 Jan 18 Voor abstract zie: Orthopedie - Jonkers F impactfactor: 2.320 9 Kerkhof D van de (Daan)