University Hospital Utrecht Research Articles

Novel finding: Proteinuria in patients with a urinary diversion does not predict renal function decline: A Cross Sectional Retrospective Study

Purpose:Proteinuria is used to track down patients with intrinsic renal disease and increased risk of renal function decline and is seen in up to 5% in the general population. The aim of this study is to investigate the prevalence and clinical relevance of proteinuria regarding renal function in patients with a urinary diversion. Methods:Data was collected of patients with a urinary diversion who had a follow-up appointment (T1) in the Urology Department of the University Hospital Utrecht in 2021. Patients were divided into a proteinuria and no proteinuria group. Proteinuria was determined through dipstick urinalysis at T1. Glomerular filtration rate and renal imaging were analysed at T1 and after 11–30 months follow-up (T2). Results:A research population of 84 patients was identified, median age was 38 years, 39.3% was male. At T1, 43% had proteinuria. There was no association between proteinuria and glomerular filtration rate nor abnormalities on renal imaging at T1 or T2. No statistically significant difference was seen in the glomerular filtration rate decline after 11–30 months between the group with and without proteinuria, determined at T1 (respectively 1.3 ± 6.9 ml/min/1.73 m2 vs 2.3 ± 9.5 ml/min/1.73 m2; p-value 0.63). Conclusion:The prevalence of proteinuria in patients with a urinary diversion is high. Proteinuria was not associated with renal function or renal function decline over time. These findings illustrate the limitations of proteinuria screening to identify individuals at risk for renal function decline among this population.

Underdiagnosis and Poor Adherence Are Contributing to Rising Cases of Hypertension

Essential hypertension, a significant risk factor for cardiovascular diseases (CVD), kidney failure, and all-cause mortality, is largely reversible with lifestyle changes and highly efficacious medications. However, the prevalence of raised blood pressure (BP) is increasing globally. Considering its lack of symptoms, many people remain undiagnosed and unaware of the risks. In addition, a lack of perceived benefit makes adhering to pharmacological and non-pharmacological interventions challenging for patients. In this article, Peter Blankestijn from University Hospital Utrecht in the Netherlands speaks about the hidden dangers of essential hypertension, and how regular BP testing and greater public awareness could help identify undiagnosed cases and reduce risk. He also explains the challenges of adherence and how healthcare professionals can support patients to make the preventative changes that could save their lives.

Postnatal growth of preterm born children ≤ 750 g at birth

Background Extremely low birth weight (ELBW) infants are at risk of impaired postnatal growth. Impaired postnatal growth has been reported to be associated with delayed cognitive and motor development. Aims To describe postnatal growth patterns of appropriate and small for gestational age (AGA and SGA) ELBW children in relation to their cognitive and motor outcome at age 5.5. Study design Retrospective cohort study. Subjects One hundred one children with a BW ≤ 750 g, born between 1996 and 2005 in the University Hospital Utrecht, The Netherlands. Outcome measures Height (Ht), weight (Wt), occipital–frontal circumference (OFC) at birth, 15 months and 2 years corrected age and 3.5 and 5.5 years. Cognitive and motor outcome at 5.5 years of age, classified as normal (Z-score ≥−1), mildly delayed (−2 ≤ Z-score <−1) or severely delayed (Z-score <−2). AGA (Ht, Wt or OFC at birth ≥−2 SDS) infants were compared with SGA (Ht, Wt or OFC at birth <−2 SDS) infants. Results Between birth and 5.5 years catch-up growth in Ht, weight for height (Wt/Ht), Wt and OFC was seen in 72.2%, 55.2%, 28.6% and 68.9% respectively of the SGA infants. For AGA infants we found substantial catch-down growth in Ht (15.4%) and Wt (33.8%). Cognitive and motor outcome was normal in 76.2% and 41.6% of the 101 children. A significantly higher percentage of normal cognitive outcome was found in AGA infants with Wt growth remaining at ≥−2 SDS compared to AGA infants with catch-down growth (83% vs 63%). Next, SGA infants who caught-up in OFC had a higher prevalence of normal cognitive outcome compared to SGA infants who did not catch-up in OFC. Furthermore, a higher percentage of severely delayed motor outcome was found in SGA infants without catch-up growth in Wt compared to SGA infants who caught-up in Wt (61.5% vs 32.2%). Conclusions Catch-up growth in Ht, Wt/Ht and OFC occurred in the majority of the SGA infants with a BW ≤ 750 g, but was less common in Wt. AGA children who remained their Wt at ≥−2 SDS have a better cognitive and motor developmental outcome at 5.5 years of age. Catch-up growth in OFC was associated with a better cognitive outcome at 5.5 years of age.

Maternal Characteristics of a Cohort of Preterm Infants with a Birth Weight ≤750 g without Major Structural Anomalies and Chromosomal Abnormalities

Our objectives were to describe the obstetric complications of women who delivered an extremely low-birth-weight infant by comparing two consecutive 5-year periods and infants appropriate for gestational age (AGA) versus infants small for gestational age (SGA). This descriptive study included women ( N = 261) who delivered an infant ≤750 g (major structural and chromosomal anomalies excluded) between 1996 and 2000 (cohort I, N = 145) and 2001 to 2005 (cohort II, N = 116) in the University Hospital Utrecht, the Netherlands. Of these, 84.3% of the multigravidas ( N = 121) had a complicated obstetric history: 46.3% miscarriage(s), 22.3% preterm deliveries, and 16.5% hypertensive disorders. In the index pregnancies ( N = 261), the most prevalent complications were hypertensive disorders (52.1%, P = 0.002; more in cohort II) and SGA ( P = 0.007), fetal distress (39.5%), and intrauterine growth restriction (32.6%) resulting in a caesarean section in 47.9% and a spontaneous vaginal delivery in 19.2%. Intrauterine deaths occurred in 35.2%, merely due to placental insufficiency (59.8%) and termination of pregnancy because of deteriorating hypertensive disorders (23.9%). A high percentage of parous mothers had a seriously complicated obstetric history. The index pregnancy was largely complicated by hypertensive disorders. The majority of infants with a birth weight ≤750 g were growth-restricted due to placental insufficiency. Follow-up is extremely important to evaluate neonatal morbidity and neurodevelopmental outcome.

Nasal Saline Irrigation for Sinonasal Disorders

Nasal Saline Irrigation for Sinonasal Disorders

Growth hormone overproduction in a patient with multiple endocrine neoplasia type I

Abstract. Hermans MMH, Lips CJM, Bravenboer B (Catharina Hospital Eindhoven, Eindhoven, and University Hospital Utrecht, Utrecht, the Netherlands). Growth hormone overproduction in a patient with multiple endocrine neoplasia type I (Case Report). J Intern Med 2000; 248: 527–532. In a 69-year-old woman with a complicated history of multiple endocrine neoplasia type I (MEN 1), growth hormone overproduction was found without clinical features of acromegaly. Zollinger-Ellison syndrome was diagnosed at the age of 36 years. Total gastrectomy and partial pancreatectomy were performed. Two years later hypercalcaemia occurred, hyperparathyroidism was suspected and three hyperplastic parathyroid glands were removed. In 1994 the plasma gastrin level was elevated and a computertomography of the abdomen revealed a 1.5-cm large pancreatic tumour. Screening of the pituitary functions was unremarkable and a magnetic resonance scan of the pituitary gland showed no abnormalities. In 1995 type II diabetes mellitus was diagnosed. In 1997 basal plasma growth hormone levels were raised and plasma IGF-I levels were alternately high and normal. The patient had no clinical signs of acromegaly, but glucose tolerance testing resulted in a paradoxical rise in growth hormone concentration compatible with the diagnosis of growth hormone overproduction. Magnetic resonance imaging of the pituitary gland revealed a microadenoma.

Nasal Saline Irrigation for Sinonasal Disorders

Nasal Saline Irrigation for Sinonasal Disorders

Is platinum-based chemotherapy with paclitaxel effective in optimally debulked patients with advanced ovarian cancer?

Objective: Suboptimally debulked patients with advanced ovarian cancer who are treated with a combination of cisplatin plus paclitaxel (TP therapy) have a better survival as compared to patients treated with a combination of cisplatin plus cyclophosphamide (CP therapy), but this advantage has not been demonstrated in optimally debulked patients. We performed a retrospective study to compare the effectiveness of TP therapy and CP therapy in optimally debulked patients. Study Design: From 1991 to 1996, 87 consecutive patients with advanced ovarian cancer treated in the University Hospital Utrecht and the St. Antonius Hospital were included in the study. Overall survival (OS) of patients treated with TP or CP were compared. Multivariable Cox-regression analysis was used to calculate a hazard rate ratio (HRR) for OS. Results: In the study period, 51 patients were treated with CP, and 36 patients were treated with TP. In the 18 patients with a tumorrest >2 cm, there was a clear, but not statistically significant benefit from TP. In 69 patients with a tumorrest ≤2 cm, life expectancy was not increased in patients treated with TP as compared to patients treated with CP (HRR 0.9 (95% CI 0.4–1.9)). Conclusion: We could not show that ovarian cancer patients with residual disease of ≤2 cm who were treated with TP had better survival as compared to patients who were treated with CP. Taking into account the high costs of treatment with TP, a randomized trial comparing the effects of TP therapy and CP therapy in optimally debulked patients is warranted.

Development and evaluation of a 27 MHz multielectrode current‐source interstitial hyperthermia system

Hyperthermia is a cancer therapy, which is mostly applied in combination with radiotherapy. The aim of hyperthermia is to increase tumor temperatures to 40 °C−45 °C. One of the heating techniques that has been developed to be combined with afterloading interstitial radiotherapy (IRT) is 27 MHz current‐source interstitial hyperthermia (IHT). A four‐channel version of a current‐source IHT system had been developed to study the effectiveness of interstitial hyperthermia in combination with IRT in tumors growing in the flank of a rat. Temperatures up to 46 °C at the edges of various solid tumors with volumes in the range 1500–2000 are easily reached within 4–10 min. Furthermore, in a collaboration between the University Hospital Utrecht and the Daniel den Hoed Cancer Center in Rotterdam, a multielectrode current‐source (MECS) IHT‐system for clinical use has been developed. Basically, this system consists of three units. First, the actual heating system, including a 27 MHz electromagnetic power unit and multielectrode applicators. Second, a 196‐channel thermometry system with manganin–constantan thermcouple thermometers. Third, a computer plus treatment control software that provides the connection between the first two units and the operator. The power unit has 2 groups of 32 channels with opposite phase. The power can be controlled separately for each channel. Temperatures are measured with seven‐point thermocouple probes inside applicators or inside extra nonheating catheters. The performance of the MECS‐IHT system was examined, focusing on the efficiency of the power deposition in tissue, the homogeneity of the temperature distribution, and on thermometry accuracy.

Paternal occupational exposures and embryo implantation rates after IVF

Objective: To investigate any influence of paternal occupational exposures on implantation rates after IVF. Design: Cohort study of couples who sought IVF treatment. Setting: University Hospital Utrecht, The Netherlands. Patient(s): The study population was composed of 726 couples pursuing IVF treatment. Intervention(s): Only the earliest IVF treatment cycle with ET was selected for the analysis. All couples filled in a generic questionnaire on lifestyle factors and details about their occupation. In addition, more detailed exposure information was obtained for pesticides with use of job-specific questionnaires and a subsequent telephone interview. Main Outcome Measure(s): The implantation rate was defined as the number of gestational sacs seen with ultrasound at 6–7 weeks of pregnancy, divided by the number of embryos replaced. Result(s): A significantly reduced implantation rate was seen among couples with male partners working in occupations with presumably high levels of organic solvent exposure. Conversely, paternal pesticide exposure was significantly associated with an increased implantation rate. Paternal exposures to metal dust or fumes and welding fumes were not related to the probability of implantation. Conclusion(s): The findings suggested that paternal organic solvent exposure decreased the implantation rate among couples undergoing IVF-ET treatment.

No beneficial effects of transdermal nicotine in patients with primary sclerosing cholangitis: Results of a randomized placebo-controlled cross-over study

NO BENEFICIAL EFFECTS OF TRANSDERMAL NICOTINE IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS: RESULTS OF A RANDOMIZED PLACEBO-CONTROLLED CROSS-OVER STUDY EE Vle~aark H.R. van Buuren l, G.E Van Ber~,e Hene~,ouwen 2, W.C.J. Hop 3, K.J. van Erpecum 2 IDept of Hepatogastroenterology, University Hospital Rotterdam, The Netherlands. ZDept of Hepatogastroenterology, University Hospital Utrecht, The Netherlands. 3Dept of Biostatistics, Erasmus University Rotterdam, The Netherlands. Smoking is associated with a decreased risk of primary sclerosing eholangitis. We aimed to explore the therapeutic efficacy and tolerance of transdermal nicotine treatment in this disease. Twelve patients (11 males; 37:~6 years; 6 with ulcerative colitis) without complete biochemical remission on ursodeoxycholic acid (14 mg/kg/day) were treated in a randomised cross-over trial with transdermal nicotine (15 mg/day) or a placebo, each for 8 weeks (4week washout period between treatments). One patient developed de novo ulcerative colitis and two patients did not complete the entire protocol because of intereurrent bacterial cholangitis. Baseline values (mean + range) were: bilirubin 1.3 (0.5-2.6), APt 2.5 (1.4-4.7), gGT 7.7 (0.7-38), AST 1.9 (0.5-3.2), ALT 2.4 (0.4-7.3) and bile salts 10.9 (2.1-39) times the upper limit of normal. No significant effect on pna'itus and fatigue was noted during either period, but a small increase in body-weight was observed during placebo treatment. No significant differences were observed between the two treatment modalities after 8 weeks for bilirubin (nicotine vs placebo: +13% vs 6% change from baseline), APh (-3% vs -17%), gGT (-11% vs -13%), AST (+2% vs -10%), ALT (-1% vs -11%) or bile salts (+36% vs -3%). In conclusion, transdermal nicotine does not seem to have a clear short-term beneficial effect in primary selerosing cholangitis patients treated with ursodeoxycholic acid. Immunology, autoimmune liver disease

Different reflux mechanisms in patients with and without esophageal erosions

Gastrointestinal Research Unit, Departments of Gastroenterology and Surgery, University Hospital Utrecht, the Netherlands

A patient with neurofibromatosis type 1 and watery diarrhea syndrome dut to a VIP producing adrenal phaeochromocytoma

Department of Internal Medicine and Endocrinology, pathology and Radiology, University Hospital Utrecht, Department of Internal Medicine, Gooi-Noord Hospital Blaricum, The Netherlands

Electronystagmographic changes in patients with unilateral vestibular schwannomas in relation to tumor progression and central compensation.

Vestibular function was studied in a group of 121 patients with unilateral vestibular schwannomas who were referred to University Hospital Utrecht between 1986 and 1996. Testing included the caloric test, torsion test, saccade test, smooth pursuit test and the registration of spontaneous nystagmus. Each patient's symptoms were taken from a chart review. The size of the tumor was expressed as the maximum extrameatal diameter in the axial plane parallel to the petrous ridge as seen in magnetic resonance imaging or computed tomography. Large tumors were significantly more often accompanied by a more severe paresis on caloric testing, a smaller gain on torsion testing, spontaneous nystagmus, an abnormal saccade test and an abnormal smooth pursuit test. The presence of spontaneous nystagmus was significantly more frequently combined with an abnormal smooth pursuit and saccade test. There was a significant correlation between the slow component's velocity of the spontaneous nystagmus and the size and progression of tumor. However, a specific relation between tumor size and central vestibular compensation could not be demonstrated.

Occupationally related exposures and reduced semen quality: a case-control study

Objective: To determine whether there is an association between abnormal semen parameters and occupational exposures to organic solvents, metals, and pesticides. Design: Case-control study using three case groups based on different cutoff values for semen parameters and one standard reference group. Setting: University Hospital Utrecht and University Hospital Rotterdam, the Netherlands. Patient(s): Male partners of couples having their first consultation at the two infertility clinics (n = 899). Intervention(s): Men provided at least one semen sample. Occupational exposure was assessed with use of job-specific questionnaires, a job exposure matrix, and measurements of metals and metabolites of solvents in urine. Main Outcome Measure(s): Standard clinical semen analyses were used to define case groups and controls. Result(s): An association between aromatic solvents and reduced semen quality was demonstrated, irrespective of the exposure assessment method used. The associations were stronger if the case definition was based on stricter cutoff values for semen parameters. Risk estimates were higher if the analysis was restricted to primary infertile men. Exposure to other pollutants at the workplace was not associated with impaired semen quality. Conclusion(s): The findings indicated an association between aromatic solvent exposure and impaired semen parameters.

The small-cell variant of mycosis fungoides. A clinicopathological and quantitative electron microscopic study on 14 patients.

Small-cell variants of Sézary syndrome and mycosis fungoides (MF) have been described. However, in these studies the nuclear area of the small-cell variant of MF (SC-MF) as compared to histological classical MF (CL-MF) was not characterized objectively by quantitative electron microscopy. In a 14-year follow-up period, of a total of 76 patch/plaque stage MF patients seen in the Department of Dermatology of the University Hospital Utrecht, 14 (18%) had an infiltrate composed of atypical lymphocytes characterized by a distinctly smaller cell diameter and smaller, hyperchromatic, deeply indented nuclei as compared to the usual cell type of MF. The aim of the investigation was to confirm this observation objectively using quantitative electron microscopy (morphometry) and to define SC-MF as compared to CL-MF. The study was performed on the 14 patients with SC-MF, and 10 patients with clinical and histological CL-MF and 4 patients with chronic eczema. Electron micrographs of sections obtained from each biopsy were analysed by computer to produce the following data: a nuclear contour index (NCI), the mean nuclear area (MNA), the mean nuclear area of the cells above the 75th percentile (P75NA) and the percentage of cells larger than 30 microm2. The values of MNA differed significantly between patients with SC-MF and those with CL-MF (17.6 vs 23.2 microm2; P = 0.02), as did the values of P75NA (20.7 vs 27.9 microm2; P = 0.01). The NCI of the SC-MF and CL-MF patients were similar. These results are consistent with our observations that SC-MF does indeed exist.

Ki-67 and p53 in T2 laryngeal cancer.

To study the relationship between the proliferative capacity, represented by the immunohistochemical labeling index (LI) of proliferation marker Ki-67, and the p53 status, as in theory an intact p53 cell cycle checkpoint system should result in a lower proliferative capacity. From a group of 128 patients with a T2 laryngeal carcinoma, presented from 1989 to 1993 at the University Hospital Utrecht, 20 patients with recurrent disease and 16 patients without recurrent disease were randomly selected. All patients received primary irradiation. Denaturing gradient gel electrophoresis and immunohistochemistry determined the p53 status. MIB-1 staining was used to determine the Ki-67 LI. In 36% of specimens we found a p53 mutation with overexpression (LI, 31%). In 8% a p53 mutation without p53 overexpression was found (LI, 18%). Forty-two percent showed no mutation but, nevertheless, overexpression (LI, 35%). Neither mutation nor overexpression was found in 14% (LI, 38%). No correlation exists between p53 status and proliferative capacity of tumors (analysis of variance [ANOVA]; P = .104). The proliferation rate as established with Ki-67 LI positively correlates with response to radiotherapy (P = .006). 1. Overexpression of wild-type p53 protein does not result in cell cycle arrest measurable by a lower Ki-67 LI in comparison with cases overexpressing mutant type p53 protein. 2. A high Ki-67 LI correlates with a favorable response to radiotherapy.

The eye in von Hippel-Lindau disease. Long-term follow-up of screening and treatment: recommendations.

Von Hippel-Lindau disease (VHL) is an autosomal dominant tumour syndrome caused by germline mutations of the VHL tumour suppressor gene located on chromosome 3p25-26. In VHL tumours may occur in 14 different target organs, including the eye. Retinal angiomas are considered the first manifestation of VHL disease in 43% of cases, and the cumulative probability of developing a retinal angioma in one or both eyes rises during each decade of life, reaching 80% for patients over 80 years old. Since 1976 patients with VHL at the University Hospital of Utrecht and their at-risk relatives have been screened periodically by a multidisciplinary team. Long-term follow-up ophthalmological data were analysed with special attention to natural course and results of treatment. In addition, we looked for a genotype-phenotype correlation. Retinal angiomas were found in all families. In one large family with a missense mutation (V170D) of the VHL gene, in which the complete spectrum of visceral- and central nervous system (CNS) features of VHL is present, macular, parapapillary, optic disc and ora serrata angiomas were also found. In general, however, a clear-cut genotype-phenotype correlation could not be found. Only early detection and treatment of peripheral retinal angiomas can be expected to decrease the percentage of patients with decreased visual acuity. Therefore, early detection and treatment of these tumours is of paramount importance. Ophthalmological screening of patients and persons at risk should start as early as possible. In patients with apparently sporadic retinal angiomas it is advisable to perform germline DNA analysis, since the risk of developing VHL is high, especially if the angiomas are bilateral, or unilateral and multifocal, if the patient is young, or if there is a family history suggestive of VHL.

Complications During Renal Artery Stent Placement for Atherosclerotic Ostial Stenosis

No AccessJournal of UrologyUrological Survey: Abstracts: Kidney Transplantation and Renovascular Hypertension1 Jun 1998Complications During Renal Artery Stent Placement for Atherosclerotic Ostial Stenosis F.J.A. Beek, R. Kaatee, J.J. Beutler, P.J. van der Ven, and W.P.T.M. Mali F.J.A. BeekF.J.A. Beek More articles by this author , R. KaateeR. Kaatee More articles by this author , J.J. BeutlerJ.J. Beutler More articles by this author , P.J. van der VenP.J. van der Ven More articles by this author , and W.P.T.M. MaliW.P.T.M. Mali More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)63327-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Complications During Renal Artery Stent Placement for Atherosclerotic Ostial Stenosis." The Journal of Urology, 159(6), pp. 2245–2246 References 1 : Atheroembolic renal disease: association with renal artery stenosis. Cleveland Clin. J. Med.1988; 56: 407. Google Scholar Departments of Radiology and Nephrology, University Hospital Utrecht, Utrecht, The Netherlands© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 159Issue 6June 1998Page: 2245-2246 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information F.J.A. Beek More articles by this author R. Kaatee More articles by this author J.J. Beutler More articles by this author P.J. van der Ven More articles by this author W.P.T.M. Mali More articles by this author Expand All Advertisement PDF DownloadLoading ...

Increased VLDL in nephrotic patients results from a decreased catabolism while increased LDL results from increased synthesis

Increased VLDL in nephrotic patients results from a decreased catabolism while increased LDL results from increased synthesis