1
|
van der Velde MGAM, Jansen MAC, de Jongh MAC, Kremers MNT, Haak HR. Implementation of a care-pathway at the emergency department for older people presenting with nonspecific complaints; a protocol for a multicenter parallel cohort study. PLoS One 2023; 18:e0290733. [PMID: 37643185 PMCID: PMC10464958 DOI: 10.1371/journal.pone.0290733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Older adults frequently attend the Emergency Department (ED) with poorly defined symptoms, often called nonspecific complaints (NSC). NSC such as 'weakness' and 'not feeling well', often lead to an extensive differential diagnosis. Patients with NSC experience a prolonged length of stay at the ED and are prone to adverse outcomes. Currently, a care pathway for patients with NSC does not exist. A special structured care pathway for patients with NSC was designed to improve the efficiency and quality of care at the ED. METHOD A multicenter parallel cohort study, organized in different hospitals in the Noord-Brabant area, the Netherlands, in which general practitioners (GP), elderly care physicians (ECP), Emergency Physicians (EP), geriatricians and internists will collaborate. Patients ≥ 70 years presenting with NSC and in need of ED admission as indicated by their own GP or ECP are eligible for inclusion. Before implementation each hospital will retrospectively include their own control-group. After implementation, patients will prospectively be included. The care-pathway exists of risk stratification by the APOP-screener, in-depth history taking, i.e. limited comprehensive geriatric assessment (CGA) and a standard set of diagnostics, and a dedicated ED-nurse (if possible) present to ensure the care-pathway is followed. The primary outcome is length of stay at the ED (LOS-ED) and perceived quality of care. Secondary outcomes are hospital length of stay, revisits, readmissions and mortality at 30- and 90-day follow-up. DISCUSSION This study proposes a structured care pathway for older patients presenting at the ED with NSCs and considering effectiveness and perceived quality this may improve acute care for these patients. TRIAL REGISTRATION Dutch Trial register, number NL8960.
Collapse
Affiliation(s)
- M. G. A. M. van der Velde
- Department of Internal Medicine, Máxima MC, Veldhoven, The Netherlands
- Department of Health Services Research, and CAPHRI School for Public Health and Primary Care, Aging and Long Term Care Maastricht, Maastricht, The Netherlands
| | | | | | - M. N. T. Kremers
- Department of Internal Medicine, Máxima MC, Veldhoven, The Netherlands
- Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - H. R. Haak
- Department of Health Services Research, and CAPHRI School for Public Health and Primary Care, Aging and Long Term Care Maastricht, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
2
|
Fassnacht M, Assie G, Baudin E, Eisenhofer G, Fouchardiere CDL, Haak HR, de Krijger R, Porpiglia F, Terzolo M, Berruti A. Corrigendum to "Adrenocortical carcinomas and malignant phaeochromocytomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up": [Annals of Oncology volume 31 (2020) 1476-1490]. Ann Oncol 2022:S0923-7534(22)04775-5. [PMID: 36564283 DOI: 10.1016/j.annonc.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- M Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg; Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - G Assie
- Department of Endocrinology, Reference Centre for Rare Adrenal Diseases, Reference Centre for Rare Adrenal Cancers, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris; Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Centre National de la Recherche Scientifique UMR8104, Université Paris Descartes, Sorbonne Paris Cité, Paris
| | - E Baudin
- Department of Endocrine Oncology and Nuclear Medicine, Gustave Roussy, Villejuif, France
| | - G Eisenhofer
- Department of Medicine III and Institute of Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
| | - C de la Fouchardiere
- Department of Medical Oncology, Centre Léon Bérard, University Claude Bernard Lyon I, Lyon, France
| | - H R Haak
- Department of Internal Medicine Máxima Medisch Centrum, Eindhoven; Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre, Maastricht; Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht
| | - R de Krijger
- Department of Pathology, University Medical Center Utrecht, Utrecht; Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - F Porpiglia
- Division of Urology, San Luigi Hospital e Orbassano, Turin; Department of Oncology, University of Turin, Turin
| | - M Terzolo
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin
| | - A Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | | |
Collapse
|
3
|
Mols EM, van der Velde M, Nanayakkara P, Haak HR, Kremers M. Evaluating quality in acute care using patient reported outcome measures: a scoping review. Acute Med 2021; 20:37-47. [PMID: 33749693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The aim of this scoping review is to identify patient reported outcome measures (PROMs) in acute care settings, assess their psychometric properties and provide recommendations for their use in daily practice. We performed a search in the PubMed database to identify publications concerning PROMs in an acute care setting. The COSMIN checklist was used to assess the psychometric properties of the reported PROMs. We found 1407 publications and included 14 articles, describing 15 measures. Most publications provided limited information on psychometric properties. Three generic PROMs were deemed of adequate quality for use in acute care. We recommend future development and evaluation of PROMs focussing on acute care to further evaluate and improve the quality of acute care.
Collapse
Affiliation(s)
- E M Mols
- Department of Internal Medicine, Máxima MC, Veldhoven/Eindhoven, the Netherlands
| | - Mgam van der Velde
- Department of Internal Medicine, Máxima MC, Veldhoven/Eindhoven, the Netherlands
| | - Pwb Nanayakkara
- Department of Health Services Research, and CAPHRI School for Public Health and Primary Care, Aging and Long Term care Maastricht, the Netherlands
| | - H R Haak
- Department of Internal Medicine, Máxima MC, Veldhoven/Eindhoven, the Netherlands
| | - Mnt Kremers
- Department of Internal Medicine, Máxima MC, Veldhoven/Eindhoven, the Netherlands
| |
Collapse
|
4
|
Fassnacht M, Assie G, Baudin E, Eisenhofer G, de la Fouchardiere C, Haak HR, de Krijger R, Porpiglia F, Terzolo M, Berruti A. Adrenocortical carcinomas and malignant phaeochromocytomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2020; 31:1476-1490. [PMID: 32861807 DOI: 10.1016/j.annonc.2020.08.2099] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/30/2020] [Accepted: 08/12/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- M Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - G Assie
- Department of Endocrinology, Reference Centre for Rare Adrenal Diseases, Reference Centre for Rare Adrenal Cancers, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France; Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Centre National de la Recherche Scientifique UMR8104, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - E Baudin
- Department of Endocrine Oncology and Nuclear Medicine, Gustave Roussy, Villejuif, France
| | - G Eisenhofer
- Department of Medicine III and Institute of Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
| | - C de la Fouchardiere
- Department of Medical Oncology, Centre Léon Bérard, University Claude Bernard Lyon I, Lyon, France
| | - H R Haak
- Department of Internal Medicine Máxima Medisch Centrum, Eindhoven, The Netherlands; Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, The Netherlands
| | - R de Krijger
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands; Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - F Porpiglia
- Division of Urology, San Luigi Hospital - Orbassano, Turin, Italy; Department of Oncology, University of Turin, Turin, Italy
| | - M Terzolo
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy
| | - A Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy
| |
Collapse
|
5
|
Creemers SG, Feelders RA, Valdes N, Ronchi CL, Volante M, van Hemel BM, Luconi M, Ettaieb MHT, Mannelli M, Chiara MD, Fassnacht M, Papotti M, Kerstens MN, Nesi G, Haak HR, van Kemenade FJ, Hofland LJ. The IGF2 methylation score for adrenocortical cancer: an ENSAT validation study. Endocr Relat Cancer 2020; 27:541-550. [PMID: 32668404 DOI: 10.1530/erc-19-0378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/13/2020] [Indexed: 11/08/2022]
Abstract
Adrenocortical carcinoma (ACC) is diagnosed using the histopathological Weiss score (WS), but remains clinically elusive unless it has metastasized or grows locally invasive. Previously, we proposed the objective IGF2 methylation score as diagnostic tool for ACC. This multicenter European cohort study validates these findings. Patient and tumor characteristics were obtained from adrenocortical tumor patients. DNA was isolated from frozen specimens, where after DMR2, CTCF3, and H19 were pyrosequenced. The predictive value of the methylation score for malignancy, defined by the WS or metastasis development, was assessed using receiver operating characteristic curves and logistic and Cox regression analyses. Seventy-six ACC patients and 118 patients with adrenocortical adenomas were included from seven centers. The methylation score and tumor size were independently associated with the pathological ACC diagnosis (OR 3.756 95% CI 2.224-6.343; OR 1.467 95% CI 1.202-1.792, respectively; Hosmer-Lemeshow test P = 0.903), with an area under the curve (AUC) of 0.957 (95% CI 0.930-0.984). The methylation score alone resulted in an AUC of 0.910 (95% CI 0.866-0.952). Cox regression analysis revealed that the methylation score, WS and tumor size predicted development of metastases in univariate analysis. In multivariate analysis, only the WS predicted development of metastasis (OR 1.682 95% CI 1.285-2.202; P < 0.001). In conclusion, we validated the high diagnostic accuracy of the IGF2 methylation score for diagnosing ACC in a multicenter European cohort study. Considering the known limitations of the WS, the objective IGF2 methylation score could potentially provide extra guidance on decisions on postoperative strategies in adrenocortical tumor patients.
Collapse
Affiliation(s)
- S G Creemers
- Division of Endocrinology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R A Feelders
- Division of Endocrinology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - N Valdes
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Asturias, Oviedo, Spain
| | - C L Ronchi
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
- Institute of Metabolism and System Research, University of Birmingham, Birmingham, UK
| | - M Volante
- Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - B M van Hemel
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Luconi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - M H T Ettaieb
- Departments of Internal Medicine and Endocrinology, Máxima Medical Center, Eindhoven, The Netherlands
| | - M Mannelli
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - M D Chiara
- Instituto Universitario de Oncologia del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - M Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - M Papotti
- Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - M N Kerstens
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G Nesi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - H R Haak
- Departments of Internal Medicine and Endocrinology, Máxima Medical Center, Eindhoven, The Netherlands
| | - F J van Kemenade
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - L J Hofland
- Division of Endocrinology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
6
|
Moafa HN, van Kuijk SMJ, Franssen GHLM, Moukhyer ME, Haak HR. What is known about the quality of out-of-hospital emergency medical services in the Arabian Gulf States? A systematic review. PLoS One 2019; 14:e0226230. [PMID: 31856219 PMCID: PMC6922377 DOI: 10.1371/journal.pone.0226230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Emergency Medical Services (EMS) have been developed in the Arabian Gulf States (AGS) in the last three decades. The EMS needs continuous quality assessment of their performance to improve and provide the best out-of-hospital care. This study aims to assess the quality of EMS in the AGS according to the six quality domains of the Institute of Medicine. METHODS We searched four databases (i.e., PubMed, EMBASE, Web of Science, and CINAHL) for studies that reported on the quality of EMS in any of the AGS using clinical or non-clinical performance indicators. To quantify study quality and risk of bias, the adapted Newcastle Ottawa Scale was used. We focused on structural and functional indicators, clinical and non-clinical. RESULTS Twenty-five studies were eligible for inclusion. One study contained result of safety, fifteen time-centeredness, twenty effectiveness, five patient-centeredness, and thirteen studies reported on equity of EMS. None of the studies reported on efficiency of EMS. A significant proportion of studies showed high scores on the Newcastle-Ottawa scale. Limited studies on EMS quality were available, not covering all relevant quality domains and not covering the whole AGS region. The equity domain showed the best outcome performance finding, whereas finding of the patient-centeredness domain showed room for improvement in the foreseeable future. CONCLUSION This review highlights the need for more and better studies of sufficient quality about all domains of quality in EMS in all the AGS. EMS research in Kuwait and Bahrain is warranted, as currently studies of EMS quality are unavailable for these States. Moreover, efficiency researches exploring this discipline should be conducted specially no studies were found has been searching this domain. TRIAL REGISTRATION PROSPERO registration number: CRD42019123896.
Collapse
Affiliation(s)
- H. N. Moafa
- Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
- * E-mail: ,
| | - S. M. J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - M. E. Moukhyer
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - H. R. Haak
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maxima Medisch Centre, Eindhoven, The Netherlands
- Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| |
Collapse
|
7
|
Wachelder J, Stassen PM, Fourmanov RS, Nickel CH, Haak HR. Higher In-Hospital Mortality in Patients with Nonspecific Complaints Presenting to the Emergency Department. Acute Med 2019; 18:232-238. [PMID: 31912054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Nonspecific complaints (NSC) at the Emergency Department (ED) are not well researched yet. OBJECTIVE To investigate the number of patients who could be classified as having NSC early after arrival in the ED using an algorithm. METHOD Retrospective cohort study was conducted among all hemodynamically stable non-trauma adult patients with MTS category orange/yellow visiting the ED. Patients who had no specific complaints/signs, predefined on a list, were categorized as NSC. RESULTS In total, 2419 patients, of whom 102 (4.2%) presented with NSC. Hospitalization was more prevalent (85.3% vs. 69.0%, p<0.001) and in-hospital mortality was higher in the NSC-group (11.8% vs. 3.5%, adjusted OR 2.0, 95% CI 1.0-3.9, p=0.04). CONCLUSION Using an algorithm it is possible to identify NSC patients who have (worse) outcomes than those classified as SC.
Collapse
Affiliation(s)
- Jjh Wachelder
- Department of Internal Medicine, Máxima Medical Centre, 5631 BM Eindhoven, the Netherlands
| | - P M Stassen
- Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, 6229 ER Maastricht, the Netherlands
| | - R S Fourmanov
- Department of Internal Medicine, Máxima Medical Centre, 5631 BM Eindhoven, the Netherlands
| | - C H Nickel
- Emergency Department, University Hospital of Basel, Switzerland
| | - H R Haak
- Department of Internal Medicine, Máxima Medical Centre, 5631 BM Eindhoven, the Netherlands
| |
Collapse
|
8
|
Wachelder JJH, van Galen LS, Kellett J, Nickel CH, Haak HR. Unplanned readmissions among patients presenting with nonspecific complaints. Eur J Intern Med 2018; 54:e36-e37. [PMID: 29885755 DOI: 10.1016/j.ejim.2018.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 05/14/2018] [Indexed: 11/17/2022]
Affiliation(s)
- J J H Wachelder
- Department of Internal Medicine, Máxima Medical Centre, 5631 BM Eindhoven/Veldhoven, The Netherlands; Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, The Netherlands; Dept. of Internal Medicine, Division of General Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands.
| | - L S van Galen
- Section Acute Medicine, Department of Internal Medicine, VU Medical Centre, Amsterdam, The Netherlands; Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - J Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - C H Nickel
- Emergency Department, University Hospital Basel, Switzerland
| | - H R Haak
- Department of Internal Medicine, Máxima Medical Centre, 5631 BM Eindhoven/Veldhoven, The Netherlands; Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, The Netherlands; Dept. of Internal Medicine, Division of General Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands
| |
Collapse
|
9
|
Zanders MMJ, Haak HR, van Herk-Sukel MPP, Herings RMC, van de Poll-Franse LV, Johnson JA. Changes in glucose-lowering drug use before and after cancer diagnosis in patients with diabetes. Diabetes Metab 2017; 44:22-29. [PMID: 29066209 DOI: 10.1016/j.diabet.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 08/11/2017] [Accepted: 08/28/2017] [Indexed: 12/18/2022]
Abstract
AIM This study explores the changes in glucose-lowering drug (GLD) use before and after cancer diagnosis among patients with diabetes. METHODS New GLD users (1998-2011) living in the Dutch ECR-PHARMO catchment area were selected from the PHARMO Database Network (n=52,228). Those with a primary cancer diagnosis were considered cases (n=3281) and matched with eligible controls (n=12,891) without cancer during follow-up. Conditional logistic regression analysis was used to assess changes in GLD use, such as treatment add-ons, treatments drops and initiation of insulin, for cases compared with controls associated with specific cancer types in four time windows (6-3 and 0-3months before cancer diagnosis; 0-3 and 3-6months after cancer diagnosis). RESULTS In the 3months before cancer diagnosis, patients with upper gastrointestinal (GI) cancers (oesophageal, stomach, pancreatic, liver cancers) had higher odds of initiating insulin (OR: 9.3; 95% CI: 3.6-24.1); to a lesser extent, this was also observed in the 3months prior to that (at 6months, OR: 3.9; 95% CI: 1.3-12.1). Diagnosis of colorectal (OR: 3.4; 95% CI: 1.4-8.4), pulmonary (OR: 2.5; 95% CI: 1.1-5.4) and upper GI (OR: 13.6; 95% CI: 5.0-36.9) cancers was associated with increased odds of initiating insulin in the 3months after cancer diagnosis. During all study time windows, the odds of treatment drops were higher for patients with upper GI cancers whereas, for most other cancers, these odds were higher only after a diagnosis of cancer. CONCLUSION The greater odds of initiating insulin during the 6months prior to diagnosis of upper GI cancers suggest reverse causation. After cancer diagnosis, drops in use of GLDs was commonly seen.
Collapse
Affiliation(s)
- M M J Zanders
- Netherlands Comprehensive Cancer Organisation,, P.O. Box 231, 5600 AE Eindhoven, The Netherlands; Department of Internal Medicine, Máxima Medical Centre, Eindhoven/Veldhoven, P.O. Box 7777. 5500 MB Veldhoven, The Netherlands.
| | - H R Haak
- Department of Internal Medicine, Máxima Medical Centre, Eindhoven/Veldhoven, P.O. Box 7777. 5500 MB Veldhoven, The Netherlands; Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, P.O. Box 5800, 6229 HX, Maastricht, The Netherlands; Maastricht University, Department of Health Services Research, and CAPHRI School for Public Health and Primary Care, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - M P P van Herk-Sukel
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands
| | - R M C Herings
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands
| | - L V van de Poll-Franse
- Netherlands Comprehensive Cancer Organisation,, P.O. Box 231, 5600 AE Eindhoven, The Netherlands; Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands; Division of Psychosocial Oncology and Epidemiology, Netherlands Cancer Institute, Amsterdam, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - J A Johnson
- School of Public Health, University of Alberta, 87 Ave, 11405 Edmonton, AB T6G 1C9, Canada
| |
Collapse
|
10
|
Abstract
Cancer of the adrenal cortex (ACC) is a rare endocrine malignancy with limited treatment options. Patients typically present with autonomous hormonal overproduction and/or a large abdominal mass. Hormonal assays and medical imaging can be diagnostic, but urinary steroid profiling might be a more sensitive technique to assess malignancy in adrenal tumours. The stage of the disease at diagnosis is the most important prognostic factor. The current staging system needs refinement, especially to separate aggressive from indolent disease in stage IV patients and to select patients who need adjuvant treatment after complete surgical resection. Regarding the latter, assessing the proliferation index Ki-67 seems the best tool currently available. Genomic profiling is expected to become of clinical relevance in the future. Medical therapy is centred on the adrenolytic drug mitotane, which carries considerable toxicity and is not easy to manage. Its tolerability and long plasma level build-up phase may be improved by therapeutic drug monitoring based on pharmacokinetic modelling and intensive counselling of patients. Current chemotherapy regimens can offer disease stabilization in about 50% of patients, but an objective response should be expected in <25%. Research on targeted therapy and immunotherapy is difficult in this rare disease with often heavily pre-treated patients and has not yet been successful. Quality of care should be ensured by treating patients in centres with established experience in multidisciplinary oncologic care, who adhere to prevailing guidelines and state-of-the-art in diagnostic and treatment concepts. International collaboration in fundamental research and clinical trials is the key to further elucidate the pathogenesis and to improve patient care.
Collapse
Affiliation(s)
- T M A Kerkhofs
- Department of Internal MedicineMaxima Medical Center, Ds. Th. Fliednerstraat 1, 5631 BM Eindhoven/Veldhoven, The NetherlandsDivision of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The NetherlandsDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareMaastricht University Medical Center, The Netherlands
| | - M H T Ettaieb
- Department of Internal MedicineMaxima Medical Center, Ds. Th. Fliednerstraat 1, 5631 BM Eindhoven/Veldhoven, The NetherlandsDivision of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The NetherlandsDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareMaastricht University Medical Center, The Netherlands
| | - I G C Hermsen
- Department of Internal MedicineMaxima Medical Center, Ds. Th. Fliednerstraat 1, 5631 BM Eindhoven/Veldhoven, The NetherlandsDivision of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The NetherlandsDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareMaastricht University Medical Center, The Netherlands
| | - H R Haak
- Department of Internal MedicineMaxima Medical Center, Ds. Th. Fliednerstraat 1, 5631 BM Eindhoven/Veldhoven, The NetherlandsDivision of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The NetherlandsDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareMaastricht University Medical Center, The Netherlands Department of Internal MedicineMaxima Medical Center, Ds. Th. Fliednerstraat 1, 5631 BM Eindhoven/Veldhoven, The NetherlandsDivision of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The NetherlandsDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareMaastricht University Medical Center, The Netherlands Department of Internal MedicineMaxima Medical Center, Ds. Th. Fliednerstraat 1, 5631 BM Eindhoven/Veldhoven, The NetherlandsDivision of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The NetherlandsDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareMaastricht University Medical Center, The Netherlands
| |
Collapse
|
11
|
Zanders MMJ, van Herk-Sukel MPP, Vissers PAJ, Herings RMC, Haak HR, van de Poll-Franse LV. Are metformin, statin and aspirin use still associated with overall mortality among colorectal cancer patients with diabetes if adjusted for one another? Br J Cancer 2015; 113:403-10. [PMID: 26180924 PMCID: PMC4522645 DOI: 10.1038/bjc.2015.259] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/31/2015] [Accepted: 06/15/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Metformin, statin and aspirin use seem associated with decreased mortality in cancer patients, though, without adjusting for one another. Independent associations of these drugs with overall mortality after colorectal cancer (CRC) diagnosis within glucose-lowering drugs (GLDs) users were assessed. METHODS Patients starting GLDs before CRC diagnosis (1998-2011) were selected from the Eindhoven Cancer Registry linked with the PHARMO Database Network. The Cox regression model, with time since CRC diagnosis, included time-dependent variables of cumulative exposure to metformin, statins and aspirin after cancer diagnosis and time-dependent ever-never terms for drug exposure. RESULTS A total of 1043 patients used GLDs before CRC diagnosis; 666 (64%) used metformin, 639 (61%) used statins and 490 (47%) used aspirin after CRC diagnosis. Multivariable analyses revealed that longer cumulative exposure to metformin was not associated with overall mortality (HRCumulative exposure/6 months 1.02; 95% CI 0.97-1.07), whereas the favourable effect of statins increased with cumulative exposure (HRCumulative exposure/6 months 0.93; 95% CI 0.89-0.98). No association between aspirin use and overall mortality was seen (HRCumulative exposure/6 months 0.98; 95% CI 0.93-1.03). CONCLUSIONS No independent association between cumulative exposure to metformin, aspirin and overall mortality was found. Cumulative exposure to statins after CRC diagnosis was associated with lower overall mortality, supporting a drug effect of statins among GLDs users.
Collapse
Affiliation(s)
- M M J Zanders
- Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands
| | - M P P van Herk-Sukel
- Department of Research, PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - P A J Vissers
- 1] Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands [2] Department of Medical and Clinical Psychology, Centre of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - R M C Herings
- Department of Research, PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - H R Haak
- 1] Department of Internal Medicine, Máxima Medical Centre, Veldhoven, The Netherlands [2] Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands [3] Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - L V van de Poll-Franse
- 1] Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands [2] Department of Medical and Clinical Psychology, Centre of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
12
|
Kerkhofs TMA, Derijks LJJ, Ettaieb MHT, Eekhoff EMW, Neef C, Gelderblom H, den Hartigh J, Guchelaar HJ, Haak HR. Short-term variation in plasma mitotane levels confirms the importance of trough level monitoring. Eur J Endocrinol 2014; 171:677-83. [PMID: 25201518 DOI: 10.1530/eje-14-0388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Mitotane is the drug of choice in patients with adrenocortical carcinoma. The anti-neoplastic effect is correlated with mitotane plasma levels, which render it crucial to reach and maintain the concentration above 14 mg/l. However, mitotane pharmacokinetics is poorly understood. The aim of this study was to investigate the variation in plasma mitotane levels during the day and the influence of a single morning dose. DESIGN A prospective case-control study was conducted to investigate the variation in plasma mitotane levels. METHODS Patients who had been treated for at least 24 weeks and had reached the therapeutic plasma level (14 mg/l) at least once were eligible. In the first group, mitotane levels were determined hourly for the duration of 8 h after administration of a single morning dose. In the second group, mitotane levels were assessed similarly without administration of a morning dose. RESULTS Ten patients were included in this study, and three patients participated in both groups. Median plasma level at baseline was 16.2 mg/l (range 11.3-23.3 mg/l) in the first group (n=7) and 17.0 mg/l (13.7-23.8) in the second group (n=6). Plasma levels displayed a median increase compared with baseline of 24% (range 6-42%) at t=4 after morning dose and a change of 13% (range -14 to 33%) at t=4 without morning dose (P=0.02). CONCLUSION A substantial increase in mitotane plasma levels was observed in steady-state patients within a period of 8 h after morning dosing. Without morning dose, mitotane curves showed a variable profile throughout the day. This implies that random sampling could yield incidentally high levels. For this reason, we recommend early-morning trough sampling as standard management in monitoring mitotane treatment.
Collapse
Affiliation(s)
- T M A Kerkhofs
- Department of Internal MedicineMáxima Medical Center, Ds. Th. Fliednerstraat 1, Eindhoven/Veldhoven 5631, The NetherlandsDepartment of Clinical PharmacologyMáxima Medical Center, Eindhoven/Veldhoven, The NetherlandsSection EndocrinologyDepartment of Internal Medicine, VU Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The NetherlandsDepartment of Clinical Pharmacy and ToxicologyMaastricht University Medical Center+, Maastricht, The NetherlandsDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareMaastricht University, Maastricht, The NetherlandsDepartments of Clinical OncologyClinical Pharmacy and ToxicologyLeiden University Medical Center, Leiden, The NetherlandsDivision of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - L J J Derijks
- Department of Internal MedicineMáxima Medical Center, Ds. Th. Fliednerstraat 1, Eindhoven/Veldhoven 5631, The NetherlandsDepartment of Clinical PharmacologyMáxima Medical Center, Eindhoven/Veldhoven, The NetherlandsSection EndocrinologyDepartment of Internal Medicine, VU Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The NetherlandsDepartment of Clinical Pharmacy and ToxicologyMaastricht University Medical Center+, Maastricht, The NetherlandsDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareMaastricht University, Maastricht, The NetherlandsDepartments of Clinical OncologyClinical Pharmacy and ToxicologyLeiden University Medical Center, Leiden, The NetherlandsDivision of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - M H T Ettaieb
- Department of Internal MedicineMáxima Medical Center, Ds. Th. Fliednerstraat 1, Eindhoven/Veldhoven 5631, The NetherlandsDepartment of Clinical PharmacologyMáxima Medical Center, Eindhoven/Veldhoven, The NetherlandsSection EndocrinologyDepartment of Internal Medicine, VU Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The NetherlandsDepartment of Clinical Pharmacy and ToxicologyMaastricht University Medical Center+, Maastricht, The NetherlandsDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareMaastricht University, Maastricht, The NetherlandsDepartments of Clinical OncologyClinical Pharmacy and ToxicologyLeiden University Medical Center, Leiden, The NetherlandsDivision of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - E M W Eekhoff
- Department of Internal MedicineMáxima Medical Center, Ds. Th. Fliednerstraat 1, Eindhoven/Veldhoven 5631, The NetherlandsDepartment of Clinical PharmacologyMáxima Medical Center, Eindhoven/Veldhoven, The NetherlandsSection EndocrinologyDepartment of Internal Medicine, VU Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The NetherlandsDepartment of Clinical Pharmacy and ToxicologyMaastricht University Medical Center+, Maastricht, The NetherlandsDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareMaastricht University, Maastricht, The NetherlandsDepartments of Clinical OncologyClinical Pharmacy and ToxicologyLeiden University Medical Center, Leiden, The NetherlandsDivision of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - C Neef
- Department of Internal MedicineMáxima Medical Center, Ds. Th. Fliednerstraat 1, Eindhoven/Veldhoven 5631, The NetherlandsDepartment of Clinical PharmacologyMáxima Medical Center, Eindhoven/Veldhoven, The NetherlandsSection EndocrinologyDepartment of Internal Medicine, VU Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The NetherlandsDepartment of Clinical Pharmacy and ToxicologyMaastricht University Medical Center+, Maastricht, The NetherlandsDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareMaastricht University, Maastricht, The NetherlandsDepartments of Clinical OncologyClinical Pharmacy and ToxicologyLeiden University Medical Center, Leiden, The NetherlandsDivision of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands Department of Internal MedicineMáxima Medical Center, Ds. Th. Fliednerstraat 1, Eindhoven/Veldhoven 5631, The NetherlandsDepartment of Clinical PharmacologyMáxima Medical Center, Eindhoven/Veldhoven, The NetherlandsSection EndocrinologyDepartment of Internal Medicine, VU Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The NetherlandsDepartment of Clinical Pharmacy and ToxicologyMaastricht University Medical Center+, Maastricht, The NetherlandsDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareMaastricht University, Maastricht, The NetherlandsDepartments of Clinical OncologyClinical Pharmacy and ToxicologyLeiden University Medical Center, Leiden, The NetherlandsDivision of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - H Gelderblom
- Department of Internal MedicineMáxima Medical Center, Ds. Th. Fliednerstraat 1, Eindhoven/Veldhoven 5631, The NetherlandsDepartment of Clinical PharmacologyMáxima Medical Center, Eindhoven/Veldhoven, The NetherlandsSection EndocrinologyDepartment of Internal Medicine, VU Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The NetherlandsDepartment of Clinical Pharmacy and ToxicologyMaastricht University Medical Center+, Maastricht, The NetherlandsDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareMaastricht University, Maastricht, The NetherlandsDepartments of Clinical OncologyClinical Pharmacy and ToxicologyLeiden University Medical Center, Leiden, The NetherlandsDivision of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - J den Hartigh
- Department of Internal MedicineMáxima Medical Center, Ds. Th. Fliednerstraat 1, Eindhoven/Veldhoven 5631, The NetherlandsDepartment of Clinical PharmacologyMáxima Medical Center, Eindhoven/Veldhoven, The NetherlandsSection EndocrinologyDepartment of Internal Medicine, VU Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The NetherlandsDepartment of Clinical Pharmacy and ToxicologyMaastricht University Medical Center+, Maastricht, The NetherlandsDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareMaastricht University, Maastricht, The NetherlandsDepartments of Clinical OncologyClinical Pharmacy and ToxicologyLeiden University Medical Center, Leiden, The NetherlandsDivision of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - H J Guchelaar
- Department of Internal MedicineMáxima Medical Center, Ds. Th. Fliednerstraat 1, Eindhoven/Veldhoven 5631, The NetherlandsDepartment of Clinical PharmacologyMáxima Medical Center, Eindhoven/Veldhoven, The NetherlandsSection EndocrinologyDepartment of Internal Medicine, VU Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The NetherlandsDepartment of Clinical Pharmacy and ToxicologyMaastricht University Medical Center+, Maastricht, The NetherlandsDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareMaastricht University, Maastricht, The NetherlandsDepartments of Clinical OncologyClinical Pharmacy and ToxicologyLeiden University Medical Center, Leiden, The NetherlandsDivision of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - H R Haak
- Department of Internal MedicineMáxima Medical Center, Ds. Th. Fliednerstraat 1, Eindhoven/Veldhoven 5631, The NetherlandsDepartment of Clinical PharmacologyMáxima Medical Center, Eindhoven/Veldhoven, The NetherlandsSection EndocrinologyDepartment of Internal Medicine, VU Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The NetherlandsDepartment of Clinical Pharmacy and ToxicologyMaastricht University Medical Center+, Maastricht, The NetherlandsDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareMaastricht University, Maastricht, The NetherlandsDepartments of Clinical OncologyClinical Pharmacy and ToxicologyLeiden University Medical Center, Leiden, The NetherlandsDivision of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands Department of Internal MedicineMáxima Medical Center, Ds. Th. Fliednerstraat 1, Eindhoven/Veldhoven 5631, The NetherlandsDepartment of Clinical PharmacologyMáxima Medical Center, Eindhoven/Veldhoven, The NetherlandsSection EndocrinologyDepartment of Internal Medicine, VU Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The NetherlandsDepartment of Clinical Pharmacy and ToxicologyMaastricht University Medical Center+, Maastricht, The NetherlandsDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareMaastricht University, Maastricht, The NetherlandsDepartments of Clinical OncologyClinical Pharmacy and ToxicologyLeiden University Medical Center, Leiden, The NetherlandsDivision of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands Department of Internal MedicineMáxima Medical Center, Ds. Th. Fliednerstraat 1, Eindhoven/Veldhoven 5631, The NetherlandsDepartment of Clinical PharmacologyMáxima Medical Center, Eindhoven/Veldhoven, The NetherlandsSection EndocrinologyDepartment of Internal Medicine, VU Medical Cent
| |
Collapse
|
13
|
Brouns SHA, Dortmans MKJ, Jonkers FS, Lambooij SLE, Kuijper A, Haak HR. Hyponatraemia in elderly emergency department patients: a marker of frailty. Neth J Med 2014; 72:311-317. [PMID: 25319856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Details on hyponatraemia in the emergency department are limited, especially regarding older patients, a population more susceptible to hyponatraemia and its effects. Our objective was to gain insight into the prevalence, aetiology, treatment and prognosis of clinically relevant hyponatraemia in elderly emergency department patients. The impact of the severity of hyponatraemia on outcome was a secondary objective. METHODS A retrospective cohort study of 1438 internal medicine patients aged ≥ 65 years presenting to the emergency department between 1 September 2010 and 31 August 2011 was performed. Clinically relevant hyponatraemia was defined as a serum sodium level < 130 mmol÷l. The reference group had a serum sodium level of 130-145 mmol÷l. Hyponatraemia was subdivided into moderate (129-125 mmol÷l), and severe (< 125 mmol÷l). RESULTS Ninety-one elderly patients (6.3%) were hyponatraemic at presentation to the emergency department. The main causes were the use of diuretics, hypovolaemia, and the syndrome of inappropriate antidiuretic hormone secretion (57.1%). Hyponatraemia was associated with higher admission rates (93.4 vs. 72.9%) and longer hospital stay (8 vs. 6 days) vs. the reference group. Three-month survival rate in hyponatraemic elderly patients was 74% (95% CI 64-84%) vs. 83% (95% CI 81-85%) in the reference group. Moderate hyponatraemia was associated with an increased risk of death (HR 1.7, 95% CI 1.2-2.4) vs. the reference group after multivariable adjustment for age and comorbidity. CONCLUSION Hyponatraemia, a common electrolyte disturbance among elderly internal medicine patients presenting to the emergency department, was associated with higher admission rates, longer hospital stay, and higher mortality rates. In particular, moderate hyponatraemia was a marker of underlying frailty and predictive of mortality.
Collapse
Affiliation(s)
- S H A Brouns
- Department of Internal Medicine, Máxima Medical Centre, Eindhoven÷Veldhoven, the Netherlands
| | | | | | | | | | | |
Collapse
|
14
|
Hermans MAW, Stelten BML, Haak HR, de Herder WW, Dercksen MW. Two patients with a neuroendocrine tumour of the small intestine and paraneoplastic myasthenia gravis. Endocrinol Diabetes Metab Case Rep 2014; 2014:140013. [PMID: 24839548 PMCID: PMC4023180 DOI: 10.1530/edm-14-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/25/2014] [Indexed: 11/20/2022] Open
Abstract
This paper reports on two patients with a long-standing diagnosis of an ENETS stage IV neuroendocrine tumour (NET) of the small intestine who developed neurological symptoms. The first patient only had bulbar symptoms and tested positive for acetylcholine receptor antibodies. The second patient had more classical symptoms of fatigable diplopia and muscle weakness of the legs, but no detectable antibodies. The diagnosis of paraneoplastical myasthenia gravis (MG) was postulated. Both patients were treated with pyridostigmine for MG and octreotide for the NETs. Interestingly, treatment of the NETs resulted in improvement of myasthenic symptoms. Paraneoplastic MG has been described to occur with certain malignancies, mainly thymoma. Herein, we prove that the association with gastrointestinal NETs, however, rare, is also one to be considered by clinicians dealing with either of these diseases. The pathogenesis has yet to be elucidated.
Collapse
Affiliation(s)
- M A W Hermans
- Department of Internal Medicine Maxima Medical Centre Ds Theodor Fliednerstr 1; 5631BM; Eindhoven The Netherlands
| | - B M L Stelten
- Department of Neurology Canisius Wilhelmina Hospital Weg door Jonkerbos 100, 6532SZ, Nijmegen The Netherlands
| | - H R Haak
- Department of Internal Medicine Maxima Medical Centre Ds Theodor Fliednerstr 1; 5631BM; Eindhoven The Netherlands
| | - W W de Herder
- Department of Internal Medicine Erasmus University Medical Centre Gravendijkwal 230, 3015CE, Rotterdam The Netherlands
| | - M W Dercksen
- Department of Internal Medicine Maxima Medical Centre Ds Theodor Fliednerstr 1; 5631BM; Eindhoven The Netherlands
| |
Collapse
|
15
|
Husson O, Mols F, Oranje WA, Haak HR, Nieuwlaat WA, Netea-Maier RT, Smit JWA, van de Poll-Franse LV. Unmet information needs and impact of cancer in (long-term) thyroid cancer survivors: results of the PROFILES registry. Psychooncology 2014; 23:946-52. [DOI: 10.1002/pon.3514] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 02/16/2014] [Accepted: 02/16/2014] [Indexed: 01/07/2023]
Affiliation(s)
- O. Husson
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology; Tilburg University; Tilburg The Netherlands
- Comprehensive Cancer Centre Netherlands South; Eindhoven The Netherlands
| | - F. Mols
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology; Tilburg University; Tilburg The Netherlands
- Comprehensive Cancer Centre Netherlands South; Eindhoven The Netherlands
| | - W. A. Oranje
- Department of Internal Medicine; TweeSteden Hospital; Tilburg The Netherlands
| | - H. R. Haak
- Department of Internal Medicine; Maxima Medical Centre; Eindhoven The Netherlands
| | - W. A. Nieuwlaat
- Department of Internal Medicine; St. Elisabeth Hospital; Tilburg The Netherlands
| | - R. T. Netea-Maier
- Department of Internal Medicine; Radboud Medical Centre; Nijmegen The Netherlands
| | - J. W. A. Smit
- Department of Internal Medicine; Radboud Medical Centre; Nijmegen The Netherlands
| | - L. V. van de Poll-Franse
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology; Tilburg University; Tilburg The Netherlands
- Comprehensive Cancer Centre Netherlands South; Eindhoven The Netherlands
| |
Collapse
|
16
|
Kerkhofs TM, Baudin E, Terzolo M, Allolio B, Chadarevian R, Mueller HH, Skogseid B, Leboulleux S, Mantero F, Haak HR, Fassnacht M. Comparison of two mitotane starting dose regimens in patients with advanced adrenocortical carcinoma. J Clin Endocrinol Metab 2013; 98:4759-67. [PMID: 24057287 DOI: 10.1210/jc.2013-2281] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Mitotane is the only approved drug for treatment of adrenocortical carcinoma. Its pharmacokinetic properties are not fully elucidated and different dosing regimens have never been compared head to head. OBJECTIVE The objective of the study was to investigate the relationship between mitotane dose and plasma concentration comparing two dosing regimens. DESIGN/SETTING This was a prospective, open-label, multicenter trial of a predefined duration of 12 weeks. PATIENTS/INTERVENTIONS Forty mitotane-naïve patients with metastatic adrenocortical carcinoma were assigned to a predefined low- or high-dose regimen by the local investigator. Thirty-two patients could be evaluated in detail. MAIN OUTCOME MEASURE The difference in median mitotane plasma levels between both treatment groups was measured. RESULTS Despite a difference in mean cumulative dose (440 ± 142 g vs 272 ± 121 g), median maximum plasma levels were not significantly different between the two groups [high dose 14.3 mg/L (range 6.3-29.7, n = 20) vs 11.3 mg/L (range 5.5-20.0, n = 12), P = .235]. Ten of 20 patients on the high-dose regimen reached plasma concentrations of 14 mg/L or greater after 46 days (range 18-81 d) compared with 4 of 12 patients on the low-dose regimen after 55 days (range 46-74 d, P = .286). All patients who reached 14 mg/L at 12 weeks displayed a level of 4.1 mg/L or greater on day 33 (100% sensitivity). There were no significant differences in frequency and severity of adverse events. Among patients not receiving concomitant chemotherapy mitotane exposure was higher in the high-dose group: 1013 ± 494 mg/L · d vs 555 ± 168 mg/L · d (P = .080). CONCLUSIONS The high-dose starting regimen resulted in neither significantly different mitotane levels nor a different rate of adverse events, but concomitant chemotherapy influenced these results. Thus, for mitotane monotherapy the high-dose approach is favorable, whereas for combination therapy a lower dose seems reasonable.
Collapse
Affiliation(s)
- T M Kerkhofs
- MD, Department of Internal Medicine, Máxima Medical Center, Ds. Th. Fliednerstraat 1, 5631 BM Eindhoven, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Zanders MMJ, van Steenbergen LN, Haak HR, Rutten HJT, Pruijt JFM, Poortmans PMP, Lemmens VEPP, van de Poll-Franse LV. Diminishing differences in treatment between patients with colorectal cancer with and without diabetes: a population-based study. Diabet Med 2013; 30:1181-8. [PMID: 23758334 DOI: 10.1111/dme.12253] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 05/14/2013] [Accepted: 06/06/2013] [Indexed: 11/29/2022]
Abstract
AIMS An increasing number of oncologists will be confronted with individuals having diabetes and cancer. We assessed changes in patient-, tumour- and treatment-related variables in patients with colorectal cancer with and without diabetes. METHODS All 17 170 cases of primary colorectal cancer between 1995 and 2010 in the South-Eastern Netherlands were included. The Cochrane-Armitage test and logistic regression analysis were used to analyse trends. RESULTS In total, 11 893 patients were diagnosed with colon cancer and 5277 with rectal cancer, of whom 1711 (14%) and 609 (12%), respectively, had diabetes at the time of cancer diagnosis. Patients with colorectal cancer with diabetes compared with those without were approximately 5 years older and more often diagnosed with proximal colon tumours (60 vs. 54%; P < 0.0001). Chemotherapy administration significantly increased in patients with stage III colon cancer with and without diabetes (from 17% in 1995-1998 to 50% in 2007-2010, 38% to 63%, respectively; P < 0.0001). However, in the most recent period, and after adjusting for the co-variables age, gender, year of diagnosis and specific co-morbidities, patients with stage III colon cancer with diabetes received adjuvant chemotherapy less frequently than those without [odds ratio 0.7 (95% CI 0.5-0.9); P = 0.002]. The proportion of patients with stage II/III rectal cancer with and without diabetes who underwent radiotherapy has been similar in recent years (91 vs. 87%). CONCLUSIONS Although the administration of chemotherapy and radiotherapy increased between 1995 and 2010 in patients with colorectal cancer with and without diabetes, patients with colorectal cancer with diabetes continue to receive chemotherapy less frequently than those without diabetes.
Collapse
Affiliation(s)
- M M J Zanders
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven, the Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Terzolo M, Baudin AE, Ardito A, Kroiss M, Leboulleux S, Daffara F, Perotti P, Feelders RA, deVries JH, Zaggia B, De Francia S, Volante M, Haak HR, Allolio B, Al Ghuzlan A, Fassnacht M, Berruti A. Mitotane levels predict the outcome of patients with adrenocortical carcinoma treated adjuvantly following radical resection. Eur J Endocrinol 2013; 169:263-70. [PMID: 23704714 DOI: 10.1530/eje-13-0242] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
CONTEXT Mitotane plasma concentrations ≥ 14 mg/l have been shown to predict tumor response and better survival in patients with advanced adrenocortical carcinoma (ACC). A correlation between mitotane concentrations and patient outcome has not been demonstrated in an adjuvant setting. OBJECTIVE To compare recurrence-free survival (RFS) in patients who reached and maintained mitotane concentrations ≥ 1 4 mg/l vs patients who did not. DESIGN AND SETTING Retrospective analysis at six referral European centers. PATIENTS Patients with ACC who were radically resected between 1995 and 2009 and were treated adjuvantly with mitotane targeting concentrations of 14-20 mg/l. MAIN OUTCOME MEASURES RFS (primary) and overall survival (secondary). RESULTS Of the 122 patients included, 63 patients (52%) reached and maintained during a median follow-up of 36 months the target mitotane concentrations (group 1) and 59 patients (48%) did not (group 2). ACC recurrence was observed in 22 patients of group 1 (35%) and 36 patients in group 2 (61%). In multivariable analysis, the maintenance of target mitotane concentrations was associated with a significantly prolonged RFS (hazard ratio (HR) of recurrence: 0.418, 0.22-0.79; P=0.007), while the risk of death was not significantly altered (HR: 0.59, 0.26-1.34; P=0.20). Grades 3-4 toxicity was observed in 11 patients (9%) and was managed with temporary mitotane discontinuation. None of the patients discontinued mitotane definitively for toxicity. CONCLUSIONS Mitotane concentrations ≥ 14 mg/l predict response to adjuvant treatment being associated with a prolonged RFS. A monitored adjuvant mitotane treatment may benefit patients after radical removal of ACC.
Collapse
Affiliation(s)
- M Terzolo
- Internal Medicine I, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Kerkhofs TMA, Verhoeven RHA, Bonjer HJ, van Dijkum EJN, Vriens MR, De Vries J, Van Eijck CH, Bonsing BA, Van de Poll-Franse LV, Haak HR. Surgery for adrenocortical carcinoma in The Netherlands: analysis of the national cancer registry data. Eur J Endocrinol 2013; 169:83-9. [PMID: 23641018 DOI: 10.1530/eje-13-0142] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Adrenocortical carcinoma (ACC) is a rare disease with an estimated incidence of one to two cases per 1 million inhabitants. The Dutch Adrenal Network (DAN) was initiated with the aim to improve patient care and to stimulate scientific research on ACC. Currently, not all patients with ACC are treated in specialized DAN hospitals. The objective of the current investigation was to determine whether there are differences in survival between patients operated on in DAN hospitals and those operated on in non-DAN hospitals. DESIGN The study was set up as a retrospective and population-based survival analysis. METHODS Data on all adult ACC patients diagnosed between 1999 and 2009 were obtained from The Netherlands Cancer Registry (NCR). Overall survival was calculated and a comparison was made between DAN and non-DAN hospitals. RESULTS The NCR contained data of 189 patients. The median survival of patients with European Network for the Study of Adrenal Tumors stages I-III disease was significantly longer for patients operated on in a DAN hospital (n=46) than for those operated on in a non-DAN hospital (n=37, 5-year survival 63 vs 42%). Survival remained significantly different after correction for sex, age, year of diagnosis, and stage of disease in the multivariate analysis (hazard ratio 1.96 (95% CI 1.01-3.81), P=0.047). CONCLUSION The results associate surgery in a DAN center with a survival benefit for patients with local or locally advanced ACC. We hypothesize that a multidisciplinary approach for these patients explains the observed survival benefit. These findings should be carefully considered in view of the aim for further centralization of ACC treatment.
Collapse
Affiliation(s)
- T M A Kerkhofs
- Department of Internal Medicine, Máxima Medical Center, Ds. Theodor Fliednerstraat 1, 5631 BM Eindhoven, Veldhoven, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Berruti A, Baudin E, Gelderblom H, Haak HR, Porpiglia F, Fassnacht M, Pentheroudakis G. Adrenal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 23 Suppl 7:vii131-8. [PMID: 22997446 DOI: 10.1093/annonc/mds231] [Citation(s) in RCA: 212] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- A Berruti
- Department of Clinical and Biological Sciences, University of Torino, Azienda Ospedaliero, Universitaria San Luigi, Orbassano, Italy
| | | | | | | | | | | | | | | |
Collapse
|
21
|
van de Poll-Franse LV, Haak HR, Coebergh JWW, Janssen-Heijnen MLG, Lemmens VEPP. Disease-specific mortality among stage I-III colorectal cancer patients with diabetes: a large population-based analysis. Diabetologia 2012; 55:2163-72. [PMID: 22526616 PMCID: PMC3390707 DOI: 10.1007/s00125-012-2555-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 03/14/2012] [Indexed: 12/23/2022]
Abstract
AIMS/HYPOTHESIS The aim of our study was to investigate overall and disease-specific mortality of colorectal cancer patients with diabetes. METHODS In this population-based study, we included all colorectal cancer patients, newly diagnosed with stage I-III cancer, between 1997 and 2007 in the registration area of the Eindhoven Cancer Registry. Stage of cancer, cancer treatment and comorbidities were actively collected by reviewing hospital medical records. Data on patients with and without diabetes were linked to Statistics Netherlands to assess vitality, date of death and underlying cause of death. Follow-up of all patients was completed until 1 January 2009. RESULTS We included 6,974 patients with colon cancer and 3,888 patients with rectal cancer, of whom 820 (12%) and 404 (10%), respectively, had diabetes at the time of cancer diagnosis. During follow-up, death occurred in 611 (50%) of 1,224 cancer patients with diabetes and 3,817 (40%) of 9,638 cancer patients without diabetes. Multivariate Cox regression analyses, adjusted for age, sex, socioeconomic status, stage, lymph nodes examined, adjuvant therapy and year of diagnosis, showed that overall mortality was significantly higher for colon (HR 1.12, 95% CI 1.01, 1.25) and rectal (HR 1.21, 95% CI 1.03, 1.41) cancer patients with diabetes than for those without. Disease-specific mortality was only significantly increased for rectal cancer patients (HR 1.30, 95% CI 1.06, 1.60). CONCLUSIONS/INTERPRETATION Diabetes at the time of rectal cancer diagnosis was independently associated with an increased risk of colorectal cancer mortality compared with no diabetes, suggesting a specific interaction between diabetes and rectal cancer. Future in-depth studies including detailed diabetes- and cancer-related variables should elucidate pathways.
Collapse
Affiliation(s)
- L V van de Poll-Franse
- Comprehensive Cancer Centre South (CCCS)/Eindhoven Cancer Registry, PO Box 231, 5600 AE, Eindhoven, the Netherlands.
| | | | | | | | | |
Collapse
|
22
|
Ruiter R, Visser LE, van Herk-Sukel MPP, Coebergh JWW, Haak HR, Geelhoed-Duijvestijn PH, Straus SMJM, Herings RMC, Stricker BHC. Risk of cancer in patients on insulin glargine and other insulin analogues in comparison with those on human insulin: results from a large population-based follow-up study. Diabetologia 2012; 55:51-62. [PMID: 21956710 PMCID: PMC3228952 DOI: 10.1007/s00125-011-2312-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 08/19/2011] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS Several publications suggest an association between certain types of insulin and cancer, but with conflicting results. We investigated whether insulin glargine (A21Gly,B31Arg,B32Arg human insulin) is associated with an increased risk of cancer in a large population-based cohort study. METHODS Data for this study were obtained from dispensing records from community pharmacies individually linked to hospital discharge records from 2.5 million individuals in the Netherlands. In a cohort of incident users of insulin, the association between insulin glargine and other insulin analogues, respectively, and cancer was analysed in comparison with human insulin using Cox proportional hazard models with cumulative duration of drug use as a time-varying determinant. The first hospital admission with a primary diagnosis of cancer was considered as the main outcome; secondary analyses were performed with specific cancers as outcomes. RESULTS Of the 19,337 incident insulin users enrolled, 878 developed cancer. Use of insulin glargine was associated with a lower risk of malignancies in general in comparison with human insulin (HR 0.75, 95% CI 0.71, 0.80). In contrast, an increased risk was found for breast cancer (HR 1.58, 95% CI 1.22, 2.05). Dose-response relationships could not be identified. CONCLUSION/INTERPRETATION Users of insulin glargine and users of other insulin analogues had a lower risk of cancer in general than those using human insulin. Both associations might be a consequence of residual confounding, lack of adherence or competing risk. However, as in previous studies, we demonstrated an increased risk of breast cancer in users of insulin glargine in comparison with users of human insulin.
Collapse
MESH Headings
- Breast Neoplasms/chemically induced
- Breast Neoplasms/complications
- Breast Neoplasms/epidemiology
- Cohort Studies
- Community Pharmacy Services
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/drug therapy
- Dose-Response Relationship, Drug
- Electronic Health Records
- Female
- Follow-Up Studies
- Humans
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Incidence
- Insulin/administration & dosage
- Insulin/adverse effects
- Insulin/analogs & derivatives
- Insulin/therapeutic use
- Insulin Glargine
- Insulin, Long-Acting/administration & dosage
- Insulin, Long-Acting/adverse effects
- Insulin, Long-Acting/therapeutic use
- Insulin, Regular, Human/administration & dosage
- Insulin, Regular, Human/adverse effects
- Insulin, Regular, Human/therapeutic use
- Male
- Medical Record Linkage
- Middle Aged
- Neoplasms/chemically induced
- Neoplasms/complications
- Neoplasms/epidemiology
- Netherlands/epidemiology
- Patient Admission
- Proportional Hazards Models
- Risk
Collapse
Affiliation(s)
- R. Ruiter
- Department of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
- Drug Safety Unit, Inspectorate of Health Care, The Hague, the Netherlands
| | - L. E. Visser
- Department of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | | | | | - H. R. Haak
- Department of Internal Medicine, Maxima Medical Centre, Eindhoven, the Netherlands
| | | | - S. M. J. M. Straus
- The Dutch Medicines Evaluation Board, The Hague, the Netherlands
- Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands
| | - R. M. C. Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
- Department of Health Policy & Management, Erasmus MC, Rotterdam, the Netherlands
| | - B. H. Ch. Stricker
- Department of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
- Drug Safety Unit, Inspectorate of Health Care, The Hague, the Netherlands
- Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
- Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands
| |
Collapse
|
23
|
Abstract
INTRODUCTION Adrenocortical carcinoma (ACC) is a rare disease which is considered resistant to many treatments. The role of radiotherapy in ACC remains unclear. In general radiotherapy is thought to be ineffective for the treatment of ACC, and therefore not often used. However, recent reports suggest the opposite. The aim of this study was to perform a retrospective analysis to evaluate the application of radiotherapy in Dutch ACC patients, and to determine the occurrence of response. MATERIALS AND METHODS The Dutch ACC Registry (no.=159) was screened for patients who had received radiotherapy between 1990 and 2008. Tumor response evaluation was performed according to the Response Evaluation Criteria In Solid Tumors (RECIST). RESULTS Only 13 patients (8% of registered patients) had received radiation therapy of whom 6 were irradiated for the palliation of painful bone metastases. In all patients this radiation resulted in pain relief. Three patients received adjuvant tumor bed radiation after resection. Four patients were radiated on irresectable tumor recurrence or tumor metastases. Two patients died soon after radiation therapy and therefore follow-up information regarding tumor response after radiation therapy of 2 patients was available. Interestingly, partial tumor response according to RECIST criteria, was observed in both patients. CONCLUSION ACC can be sensitive to radiotherapy and should be considered in the treatment of advanced ACC, particularly in worrisome lesions. The role of radiotherapy in advanced ACC is to complement a systemic treatment such as mitotane or classic cytotoxic agents.
Collapse
Affiliation(s)
- I G C Hermsen
- Department of Internal Medicine, Máxima Medical Centre, PO Box 90052, 5600 PD Eindhoven, The Netherlands.
| | | | | | | | | |
Collapse
|
24
|
Abstract
Adrenal incidentalomas are a common finding due to the increasing use and improved technology of imaging studies. The majority of these enlargements are non-functional and irreversible. Publications on reversible adrenal enlargement are sparse. Our patient, a 66-year-old man, was admitted to the hospital due to abdominal discomfort. He was treated for rectal carcinoma 3 years before, and was now free of disease. Computed tomography (CT) scan showed no abnormalities other than the incidental finding of bilateral adrenal enlargement. Metastasis was suspected. The CEA-level, however, was within normal range and there was no evidence of hormonal overproduction. After 1 month the patient was reviewed. Physical examination and laboratory testing were normal. Surprisingly, the CT-scan showed a decreased size of both adrenals and after 3 months even showed completely normalized adrenals. Reversible adrenal enlargements are rare. Commonly described causes of adrenal enlargement are haematomas, cystic lesions and infections of the adrenal glands. The patient in this case did not show any clinical, laboratory or radiological signs of any of these diagnoses. The current existing differential diagnosis for bilateral adrenal enlargement is not sufficient to explain the findings in our patient.
Collapse
Affiliation(s)
- I G Hermsen
- Department of Internal Medicine, Máxima Medical Centre, P.O. Box 90052, 5600 PD, Eindhoven, The Netherlands.
| | | | | |
Collapse
|
25
|
|
26
|
Abstract
OBJECTIVE Adrenal cortical carcinoma (ACC) is an aggressive tumour with a high mortality. We describe six patients living 12-28 years despite recurrent and/or metastatic ACC. PATIENTS The first patient presented in 1979 with an ACC of 8 cm. After resection, she developed seven recurrences for which she was treated with resection and/or mitotane (o,p'-DDD) treatment. The patient is still alive 28 years after diagnosis. The second patient presented with an ACC of 9 cm. After resection, the patient developed liver metastases, which were treated with o,p'-DDD. The patient is still alive 25 years after diagnosis. The third patient presented with an ACC of 12 cm. The tumour was resected followed by o,p'-DDD treatment. She had a local recurrence that was completely resected. She is still alive 18 years after diagnosis. The fourth patient presented with an ACC of 14 cm. After resection, adjuvant o,p'-DDD was started. Subsequently, the patient developed two recurrences, which were resected. He is still alive 17 years after the initial diagnosis. The fifth patient presented with an ACC of 10 cm. After diagnosis, she developed lung metastasis, which were treated with o,p'-DDD and chemotherapy. The patient is still alive with slowly progressive disease 12 years after diagnosis. The sixth patient presented with an ACC of 7 cm. After resection, she developed four recurrences, which were resected. The patient is still alive 28 years after diagnosis. CONCLUSION Some patients can have an extremely long survival of ACC, despite recurrent disease and metastases. The mainstay of therapy in our patients was repeated surgery and o,p'-DDD.
Collapse
Affiliation(s)
- I G C Hermsen
- Department of Internal Medicine, Máxima Medical Centre, PO Box 90052, 5600 PD Eindhoven, The Netherlands
| | | | | | | | | |
Collapse
|
27
|
van Ditzhuijsen CIM, van de Weijer R, Haak HR. Adrenocortical carcinoma. Neth J Med 2007; 65:55-60. [PMID: 17379929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Adrenocortical carcinoma is a rare disease with a poor prognosis. Patients can present with a hormonal syndrome or with general symptoms from an abdominal mass. The pathogenesis is unknown. Sometimes the adrenocortical carcinoma is associated with tumour syndromes such as the Beckwith-Wiedemann and Li-Fraumeni syndrome; however, most tumours are sporadic. Using one of the international classification methods, histopathological research can in almost all cases distinguish between adrenocortical adenoma and carcinoma. complete surgical resection is the treatment of choice for adrenocortical carcinoma. Mitotane is given when surgery is not possible, after incomplete resection or for metastatic disease. Frequently used chemotherapeutic combinations are etoposide, doxorubicin, cisplatin and mitotane (EDP/M) and streptozotocin and mitotane (SZ/M). International and national cooperation has resulted in a randomised trial aimed at determining a standard therapy in advanced adrenocortical carcinoma. The Dutch Adrenal Network is a national cooperation of endocrinologists, pathologists and oncologists from all eight academic centres and Máxima Medical centre. The network combines knowledge and expertise and gives patients the opportunity to receive optimal treatment in their own district.
Collapse
Affiliation(s)
- C I M van Ditzhuijsen
- Department of Internal Medicine, Máxima Medical Centre Eindhoven, Ds. Th. Fliednerstraat 1, 5600 PD Eindhoven, the Netherlands
| | | | | |
Collapse
|
28
|
Bodelier AGL, Haak HR. [Gastroenteropancreatic neuroendocrine tumours (carcinoid tumours): definition, clinical aspects, diagnosis and therapy]. Ned Tijdschr Geneeskd 2006; 150:1868-72. [PMID: 16970007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Carcinoid tumours are rare neuroendocrine tumours. In 2000 the WHO developed a new classification which gives a better description of the characteristics and biological behaviour of the tumour. Their advised designation is gastroenteropancreatic neuroendocrine tumour (GEP-NET). Somatostatin receptor scintigraphy has the highest sensitivity for visualisation of GEP-NETs. In the recent past years new positron emission tomography (PET) tracers have been developed and PET scanning is likely to become an important tool in the near future. Surgical resection is the treatment of first choice for a patient with a GEP-NET. In metastatic disease a number of forms ofpalliative treatment are possible. Cytotoxic chemotherapy seems only to be effective in aggressive, poorly-differentiated tumours. Therapy with somatostatin analogues leads to objective tumour regression in a minority of patients only. New advances in peptide receptor radionuclide therapy using radioactive-labelled somatostatin analoga are showing better results.
Collapse
Affiliation(s)
- A G L Bodelier
- Máxima Medisch Centrum, afd Interne Geneeskunde, Eindhoven.
| | | |
Collapse
|
29
|
Kuijpens JLP, Verheij CDGW, Haak HR, Ribot JG, Hoekstra OS, Coebergh JWW. [Surgery and follow-up 131I therapy in patients with differentiated thyroid carcinoma in the south-east of the Netherlands, 1983-1996, compliance with the 1987 consensus guidelines: additional data]. Ned Tijdschr Geneeskd 2004; 148:1835-6. [PMID: 15495514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
In a previous study using data from the regional cancer registry of the Comprehensive Cancer Centre South, Eindhoven, The Netherlands, we concluded that in the majority of cases surgical treatment was in accordance with the consensus recommendations, but that about 40% of patients with differentiated thyroid cancer from a number of regional hospitals had not been referred for 131I therapy. However, in a subsequent study using patient data from these hospitals, it became clear that almost all patients had in fact been referred for therapy but to centres outside the 131I therapy region. The conclusion of the study should therefore be altered: the great majority of patients with differentiated thyroid cancer in the south-east of The Netherlands (1983-96) were referred for 131I treatment and therefore the primary surgical and the follow-up treatment complied with the 1987 consensus guidelines.
Collapse
Affiliation(s)
- J L P Kuijpens
- Integraal Kankercentrum Zuid, Postbus 231, 5600 AE Eindhoven.
| | | | | | | | | | | |
Collapse
|
30
|
Rikken NET, Klinkhamer PJJM, Haak HR. Interstitial pneumonia and hepatitis caused by minocycline. Neth J Med 2004; 62:62-4. [PMID: 15127834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A 28-year-old patient is described who presented with progressive dyspnoea and jaundice due to interstitial pneumonia and hepatitis. The most likely cause is a drug-related reaction to minocycline. We discuss the different kinds of drug-related reactions that are most likely involved.
Collapse
Affiliation(s)
- N E T Rikken
- Department of Internal Medicine, Maxima Medical Centre, Eindhoven, The Netherlands.
| | | | | |
Collapse
|
31
|
Kuijpens JLP, Hoekstra OS, Hamming JF, Haak HR, Ribot JG, Coebergh JWW. [Surgery and referral for subsequent 131I therapy for patients with differentiated thyroid carcinoma in the south-east of the Netherlands, 1983-1996, compared to the consensus guidelines from 1987]. Ned Tijdschr Geneeskd 2002; 146:473-7. [PMID: 11913113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To evaluate the treatment of patients with differentiated (papillary or follicular) thyroid cancer in general hospitals in the south-east of the Netherlands during the period 1983-1996, in relation to the 1987 national consensus recommendations. DESIGN Population-based, retrospective, descriptive. METHOD For the period 1 January 1983-31 December 1996, data on the histology, TNM-stage and treatment (hospital, specialist, type of operation, referral for 131I therapy) of all 236 patients with differentiated thyroid cancer were obtained from the cancer registry of the Comprehensive Cancer Centre South, Eindhoven, the Netherlands. The treatment was compared with the recommendations from the consensus meeting in 1987. RESULTS Data on 219 patients (137 papillary, 82 follicular thyroid carcinoma) treated in the general hospitals in the region were studied; the 17 remaining patients had been referred from outside the region. Patients were treated at all hospitals in the region; the number of specialists per hospital able to treat thyroid carcinoma (internist and/or surgeon) was limited. In total 79% of the patients underwent a (near-)total thyroidectomy, half of them in two phases, and in 12% of the cases combined with regional lymph node dissection. In the majority of cases, surgical treatment was in accordance with the consensus recommendations: 65-100% of the cases per hospital. The proportion of patients referred for 131I therapy varied from 17% to 90%; referral was more frequent in the case of larger tumours and/or metastases. Of the 24 patients with a small papillary carcinoma without metastases, 79% were not referred for 131I therapy. CONCLUSIONS The recommendations laid down in the consensus meeting in 1987 were known and appeared to be followed for surgical treatment but for subsequent 131I therapy they appeared to be interpreted differently. A review of the consensus guidelines seems to be worthwhile.
Collapse
|
32
|
Gisbertz IA, Bergmans DC, van Marion-Kievit JA, Haak HR. Concurrent Whipple's disease and Giardia lamblia infection in a patient presenting with weight loss. Eur J Intern Med 2001; 12:525-8. [PMID: 11711278 DOI: 10.1016/s0953-6205(01)00165-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Whipple's disease is an uncommon systemic disease caused by the recently cultured Tropheryma whippelii, classically presenting with gastrointestinal symptoms. We report a patient with weight loss and malabsorption in which Whipple's disease and concurrent Giardia lamblia infection were diagnosed. Moreover, multiple small bowel polyps were present. The relationship between concurrent Whipple's disease and Giardia lamblia infection is discussed.
Collapse
Affiliation(s)
- I A Gisbertz
- Department of Internal Medicine, Diaconessenhuis Eindhoven, P.O. Box 90.052, 5600 PD, Eindhoven, The Netherlands
| | | | | | | |
Collapse
|
33
|
Abstract
Methods of meta-analysis, decision analysis, and cost-effectiveness analysis were applied to the adrenal incidentaloma dilemma. It was shown that the life expectancy of patients with adrenal incidentalomas is decreased by a mean of about 1 year if left undiagnosed and untreated--more in cases of larger incidentalomas. Overall, selective analysis of adrenomedullary hormonal function (by urinary metanephrines) is the most cost-effective strategy. Other strategies, such as more extensive hormonal testing, imaging, and fine needle aspiration cytology may provide better cost-effectiveness in subgroups of patients, identified by signs, symptoms, and incidentaloma morphology. Full adrenal hormonal analysis is indicated in patients with larger (> or = 6 cm) incidentalomas and if the combination of hypertension and hypokalemia suggests Conn's disease. Small or medium-sized adrenal incidentalomas may be ignored if MR imaging or other tests suggest benign pheochromocytoma disorder, or patients are elderly, or both.
Collapse
Affiliation(s)
- J Kievit
- Medical Decision Making Unit, Leiden University Medical Center, The Netherlands.
| | | |
Collapse
|
34
|
Vlasveld LT, Pauwels P, Ermens AA, Aarnoudse WH, Ooms HW, Haak HR. Parathyroid hormone-related protein (PTH-rP)-associated hypercalcemia in a patient with an atypical chronic lymphocytic leukemia. Neth J Med 1999; 54:21-6. [PMID: 10048292 DOI: 10.1016/s0300-2977(98)00099-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We describe a patient with an atypical chronic lymphocytic leukemia (CLL) of the mixed cell type with a hypercalcemia due to parathyroid hormone-related protein production by the malignant B cells. On regard of the elevated serum calcium level without overt lytic bone lesions we found elevated serum levels of PTH-rP and demonstrated the presence of PTH-rP on the malignant lymphocytes. PTH-rP-related hypercalcemia in CLL is very rare. The role in PTH-rP in humoral hypercalcemia of malignancy is discussed.
Collapse
Affiliation(s)
- L T Vlasveld
- Department of Internal Medicine, Diaconessenhuis, BM Eindhoven, The Netherlands
| | | | | | | | | | | |
Collapse
|
35
|
Kuijpens JL, Hansen B, Hamming JF, Ribot JG, Haak HR, Coebergh JW. Trends in treatment and long-term survival of thyroid cancer in southeastern Netherlands, 1960-1992. Eur J Cancer 1998; 34:1235-41. [PMID: 9849486 DOI: 10.1016/s0959-8049(98)00133-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thyroid cancer (TC), comprising less than 1% of all cancers in the Netherlands, has a good prognosis in general. Controversy still remains on the extent of surgical treatment and the indication for additional Iodine-131 (131I) therapy in the management of differentiated TC. The aim of this study was to describe (changes in) the treatment of TC and to determine independent prognostic factors for crude and relative survival of differentiated TC diagnosed in general hospitals. This population-based, retrospective study was based on data from the Eindhoven Cancer Registry, Comprehensive Cancer Centre South (I.K.Z.), Eindhoven, the Netherlands. Data were collected on all 343 TC patients diagnosed from 1 January 1960 to 31 December 1992. All available information on treatment (initial and additional) and survival (on 1 April 1994) were recorded. Initial surgical treatment was defined as limited or extended. Multivariate analysis of crude and relative survival to determine prognostic factors for differentiated TC was performed. Mean follow-up was 7.6 years. The proportion of patients with differentiated TC increased from 60% in 1960-1972 to 84% in 1985-1992. TC patients were treated in all hospitals in the region, approximately 2-4/year. Ninety per cent of all TC patients initially underwent surgical treatment; the extended procedures increasing from 27% in 1960-1974 to 61% in 1985-1992. 131I was also administered increasingly (from 18-44%) to patients with differentiated TC. The relative 5, 10 and 20 year survival rates for all TC were 80, 75 and 75%, respectively. In the first 5 years after diagnosis the crude death ratio was higher with the rise of age and for the follicular type and after 5 years for males and advanced disease. After inclusion of surgical treatment into the model, the estimates of the other death ratios did not change. Patients treated with 131I did better only during the first 5 years. Although the prognosis for TC patients treated in general hospitals in Southeastern Netherlands was similar to that found for patients treated in referral centres, concentration of treatment should be considered.
Collapse
Affiliation(s)
- J L Kuijpens
- Comprehensive Cancer Centre South (I.K.Z.), Eindhoven, The Netherlands
| | | | | | | | | | | |
Collapse
|
36
|
Abstract
There are limited data to suggest that abnormalities of p53 expression may be a late event in the development of adrenocortical tumours. This has been investigated further by examining a series of adrenocortical adenomas and carcinomas by immunohistochemistry for p53 expression and a subset for evidence of mutation in exons 5-8 of the p53 gene using polymerase chain reaction/single strand conformational polymorphism (PCR/SSCP). In carcinomas, the findings have been correlated with survival data and with tumour ploidy. Immunopositivity for p53 was seen in 4 of 34 adenomas and 22 of 42 carcinomas. Mobility shifts were identified in 1 of 4 adenomas and 10 of 21 carcinomas. There was no correlation between immunostaining pattern or PCR/SSCP evidence of mutation and either survival or disease-free survival in carcinoma. There was also no correlation between p53 status and tumour ploidy. While these findings support a role for p53 in tumour progression, abnormal p53 expression does not appear to have any significant prognostic effect in carcinoma.
Collapse
Affiliation(s)
- A M McNicol
- University Department of Pathology, Glasgow Royal Infirmary University NHS Trust, U.K
| | | | | | | | | | | |
Collapse
|
37
|
Camps MJ, van Geel JL, Haak HR, Ribot JG, Blonk MC, Bravenboer B. Short-term results of Na131I treatment of hyperthyroidism evaluated using an extended dosimetric method. Neth J Med 1996; 49:143-9. [PMID: 8937082 DOI: 10.1016/0300-2977(96)00037-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess and evaluate the short-term results of radio-iodine treatment using an extended dosimetric method. METHODS Sixty-five patients with Graves disease (GD) and 32 patients with toxic multinodular goitre (TMG) received a pre-therapeutic dosage of Na123I. The overall indicative radiation dose (Dind) and the indicative dosage (Aind) was calculated for the individual patient using the dosimetric results found. In the therapeutic setting dosimetric measurements were performed again. The quotient of the administered dose (A) and the indicative dosage and the quotient of the absorbed radiation dose (Dabs) and the indicative radiation dose were used to evaluate treatment results after 1 year of follow-up. RESULTS Clinical outcome after 1 year for GD was 26% hyper-, 48% eu- and 26% hypothyroidism and for TMG 32, 59 and 9%, respectively. Within the percentile range P25-P75 of A/Aind these results were 27, 46 and 27% for GD and 36, 64 and 0% for TMG. Within the percentile range P25-P75 of Dabs/Dind these results were 23, 59 and 18% for GD and 33, 67 and 0 for TMG. Correlation coefficients between pre- and therapeutic dosimetric measurements in GD and TMG were 0.76 and 0.38, respectively. CONCLUSIONS The short-term outcome after 1 year of follow-up is 48 and 59% euthyroidism for GD and TMG, respectively. Clinical outcome within the percentile range P25-P75 of A/Aind did not change these results. Within the percentile range P25-P75 of Dabs/Dind euthyroidism was achieved in 59% and 67% for GD and TMG, respectively. The pre-therapeutic values inaccurately represent the therapeutic values for GD and even more for TMG.
Collapse
Affiliation(s)
- M J Camps
- Department of Internal Medicine, Catharina Hospital, Eindhoven, Netherlands
| | | | | | | | | | | |
Collapse
|
38
|
van Hoek B, Ringers J, Kroes AC, van Krieken JH, van Schelven WD, Masclee AA, van Krikken-Hogenberk LG, Haak HR, Lamers CB, Terpstra OT. Temporary heterotopic auxiliary liver transplantation for fulminant hepatitis B. J Hepatol 1995; 23:109-18. [PMID: 7499780 DOI: 10.1016/0168-8278(95)80323-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND/AIMS Orthotopic liver transplantation has been shown to improve survival in fulminant hepatic failure. However, after orthotopic liver transplantation life-long immunosuppression is necessary and graft complications may occur. METHODS We employed heterotopic auxiliary liver transplantation in a 26-year-old man with fulminant hepatic failure due to hepatitis B virus infection. RESULTS From a comatose state with seizures and decerebrate posturing, the patient woke up the day after heterotopic auxiliary liver transplantation. The graft functioned sufficiently. After 2 weeks, when peritonitis developed, immunosuppression was stopped since the native liver was recovering as shown by serial HIDA scans, liver biopsies, clotting parameters and serum bilirubin. When severe rejection of the graft developed 2 weeks later, and the peritonitis had been treated successfully, the native liver had recovered sufficiently to allow the graft to be removed. Now, more than 1 year after heterotopic auxiliary liver transplantation, the patient is free from medication and he is immune for hepatitis B virus, his liver tests have returned to normal and he has regained his normal life. CONCLUSIONS Temporary heterotopic auxiliary liver transplantation for fulminant hepatitis B is feasible.
Collapse
Affiliation(s)
- B van Hoek
- Department of Gastroenterology and Hepatology, Diaconess Hospital Eindhoven, The Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
BACKGROUND The syndrome of multiple endocrine neoplasia type 1 frequently involves the adrenal cortex. The relationship between the diffuse neuroendocrine system and the adrenal cortex is not clear however, particularly as the adrenal cortex is not considered to be an intrinsic part of the diffuse neuroendocrine system. METHODS The possible relationship between the adrenal cortex and the diffuse neuroendocrine system was investigated in a study of the immunohistochemical characteristics of ten normal adrenal glands, four adrenal adenomas, and 18 adrenocortical carcinomas using the indirect peroxidase method of staining intermediate filaments and neuroendocrine proteins. RESULTS With synaptophysin, NSE, and vimentin there was focal staining in only few zona glomerulosa cells in the normal adrenal cortex, whereas adrenocortical carcinomas and adenomas were extensively positive for these proteins. Keratin immunoreactivity, present in 100% of the normal cortices, was demonstrable in only half of the carcinomas and absent in all adenomas. CONCLUSIONS Adrenocortical tumors may originate from neuroendocrine foci. The findings illuminate the pathogenesis of adrenocortical carcinoma, and may carry significant implications about the choice of treatment of patients with this malignancy and other related tumors.
Collapse
Affiliation(s)
- H R Haak
- Department of Endocrinology, University Hospital Leiden, The Netherlands
| | | |
Collapse
|
40
|
Abstract
BACKGROUND Hirsutism in women is usually caused by benign adrenal or ovarian disorders, but it can also be caused by adrenal carcinoma. The most effective way to identify such carcinomas is not known. METHODS We measured serum and urinary steroids before and after the administration of 3 mg of dexamethasone per day for five days in 14 hirsute women with histologically proved adrenal tumors (12 adrenal carcinomas and 2 adrenal adenomas) and in 73 women with hirsutism of non-neoplastic origin. RESULTS All the women with adrenal tumors had elevated basal serum concentrations of testosterone or dehydroepiandrosterone sulfate, as compared with 36 of the 73 women with non-neoplastic hirsutism (sensitivity, 100 percent; 95 percent confidence interval, 77 to 100; specificity, 50 percent; 95 percent confidence interval, 38 to 62). After the administration of dexamethasone, serum dehydroepiandrosterone sulfate concentrations and urinary 17-ketosteroid excretion decreased to values similar to those in normal women in all the women with non-neoplastic hirsutism, but in none of the 12 with adrenal tumors who were tested. All the women who did not have adrenal tumors had serum cortisol concentrations below 3.3 micrograms per deciliter (90 nmol per liter) after dexamethasone administration, whereas in all 12 patients tested who had tumors the values were higher. The suppression of serum dehydroepiandrosterone sulfate and cortisol and urinary 17-ketosteroid excretion excluded the likelihood of adrenal tumors with a sensitivity of 100 percent (95 percent confidence interval, 74 to 100) and a specificity of 100 percent (95 percent confidence interval, 89 to 100). CONCLUSIONS Among women with hirsutism, an adrenal tumor is unlikely if the patient has normal basal serum concentrations of testosterone and dehydroepiandrosterone sulfate. In women in whom these concentrations are elevated, a tumor is unlikely if the serum concentration of dehydroepiandrosterone sulfate and urinary 17-ketosteroid excretion are in the normal basal range and the serum cortisol concentration is less than 3.3 micrograms per deciliter after the administration of dexamethasone.
Collapse
Affiliation(s)
- J Derksen
- Department of General Internal Medicine, University Hospital, Leiden, The Netherlands
| | | | | | | | | |
Collapse
|
41
|
Haak HR, Hermans J, van de Velde CJ, Lentjes EG, Goslings BM, Fleuren GJ, Krans HM. Optimal treatment of adrenocortical carcinoma with mitotane: results in a consecutive series of 96 patients. Br J Cancer 1994; 69:947-51. [PMID: 8180029 PMCID: PMC1968906 DOI: 10.1038/bjc.1994.183] [Citation(s) in RCA: 236] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Mitotane is considered to be the drug of choice for patients with inoperable, recurrent and metastatic adrenocortical carcinoma, although a favourable effect of this drug on survival has never been documented. We evaluated the efficacy of mitotane treatment of 96 patients with adrenocortical carcinoma followed up in our department between 1959 and 1992. Complete tumour resection was the goal of the initial treatment. Mitotane treatment was classified according to serum trough concentrations on maintenance therapy: low (< 14 mg l-1) or high (> or = 14 mg l-1). Total tumour resection was feasible in 47 patients (49%), and subtotal resection was performed in 37 patients (39%). Patients who underwent total tumour resection survived significantly longer than those who did not (P < 0.001). Adjuvant mitotane therapy (n = 11) did not influence survival after total resection. Sixty-two patients were given mitotane treatment at some time during their illness, only 30 of whom reached high maintenance serum levels. Mitotane treatment with high serum levels had an independently favourable influence on patient survival, using univariate (P < 0.01) and multivariate analysis (P = 0.01). Mitotane treatment resulting in low serum levels was tantamount to not giving mitotane at all. We conclude that mitotane treatment in adrenocortical carcinoma is effective only when high serum levels can be achieved.
Collapse
Affiliation(s)
- H R Haak
- Department of Endocrinology, University Hospital Leiden, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
42
|
Haak HR, Cornelisse CJ, Hermans J, Cobben L, Fleuren GJ. Nuclear DNA content and morphological characteristics in the prognosis of adrenocortical carcinoma. Br J Cancer 1993; 68:151-5. [PMID: 8318407 PMCID: PMC1968309 DOI: 10.1038/bjc.1993.304] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Prognostic factors are needed for the management of patients with adrenocortical tumours. For this reason, the nuclear DNA content of patients with adrenocortical tumours was analysed by flow cytometry. The relationships between nuclear DNA content, histological indices, and clinical parameters were studied. DNA ploidy could be evaluated in 54 carcinoma and 31 adenoma patients. Twenty-one (68%) of the adenomas, and 6 (11%) of the carcinomas, were DNA diploid. Hypo/Hyperdiploidy was found in 5 (16%) of the adenomas, and 15 (28%) of the carcinomas. The remaining patients had a DNA index above 1.40. A shorter survival was found in patients with diploid carcinomas (P < 0.05). A longer disease-free survival was seen in patients with hypo/hyperdiploid carcinomas (P < 0.05). Nuclear DNA content was not related to the histological index, nor to clinical parameters. We conclude that nuclear DNA content is related to (disease-free) survival of patients with adrenocortical carcinomas. An adenoma-carcinoma sequence may be present in the adrenal cortex. In adrenocortical tumours ploidy evolution appears to be different than that observed in other solid tumours.
Collapse
Affiliation(s)
- H R Haak
- Department of Endocrinology, University Hospital Leiden, The Netherlands
| | | | | | | | | |
Collapse
|
43
|
van der Hulst RW, Haak HR, Meinders AE. A new diagnostic approach in Cushing's syndrome? Neth J Med 1993; 42:1-4. [PMID: 8383304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- R W van der Hulst
- Department of General Internal Medicine, University Hospital Leiden, Netherlands
| | | | | |
Collapse
|
44
|
Haak HR, van Seters AP, Moolenaar AJ, Fleuren GJ. Expression of P-glycoprotein in relation to clinical manifestation, treatment and prognosis of adrenocortical cancer. Eur J Cancer 1993; 29A:1036-8. [PMID: 8098948 DOI: 10.1016/s0959-8049(05)80219-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The presence of P-glycoprotein, associated with multiple drug resistance and present in the normal adrenal cortex, was studied in 15 cases of adrenocortical carcinoma. P-glycoprotein was found in eight tumours; no correlation was found with clinical presentation, steroid production or histological index. 10 patients received mitotane. Remarkably, 3 patients with P-glycoprotein-positive tumours achieved complete remission. On the other hand, 2 patients with P-glycoprotein-negative tumours showed progression of the disease despite mitotane treatment. These findings suggest that the expression of P-glycoprotein in adrenocortical carcinoma is not related to clinical manifestations, steroid production, histological index or response to mitotane therapy.
Collapse
Affiliation(s)
- H R Haak
- Department of Internal Medicine, Diaconessenhuis, Eindhoven, The Netherlands
| | | | | | | |
Collapse
|
45
|
Lanser JB, van Seters AP, Moolenaar AJ, Haak HR, Bollen EL. Neuropsychologic and neurologic side effects of mitotane and reversibility of symptoms. J Clin Oncol 1992; 10:1504. [PMID: 1517795 DOI: 10.1200/jco.1992.10.9.1504] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
|
46
|
Abstract
After finding prolonged bleeding times in 2 patients treated with mitotane, we prospectively studied 7 patients with adrenocortical cancer on mitotane therapy. Before and 1 and 2 or more weeks after starting mitotane we determined the platelet counts, bleeding times and global coagulation parameters. All patients had a normal bleeding time before treatment. In 6 cases the bleeding time became prolonged (245-555 s). 4 patients exhibited platelet aggregation responses compatible with an aspirin-like defect. It is concluded that mitotane may cause a clinically relevant defect of platelet function.
Collapse
Affiliation(s)
- H R Haak
- Department of Endocrinology, University Hospital Leiden, The Netherlands
| | | | | | | |
Collapse
|
47
|
Abstract
Flow cytometry of medullary thyroid carcinoma (MCT) was performed in a large family with the MEN-2A syndrome. Of 15 family members with MCT five patients (10-27 yr) were without lymph node metastases. Six patients had a normal pentagastrin test after operation. All patients are alive and free of symptoms of MCT 6-9 yr after total thyroidectomy and an ablative dose of 131-I. In 12 of the 15 patients with MCT flowcytometry of paraffin-embedded tissue could be performed. The majority of all tumors (n = 9) were classified as peridiploid. Metastatic tumor, 6 years after thyroidectomy, in one of the patients was diploid. Only two MCT were clearly aneuploid. In one patient the tumor was tetraploid. We conclude that the majority of the MCT patients in this family with the MEN-2A syndrome have no or limited ploidy aberrations in their tumors, which correlates well with the favourable prognosis of familial MCT.
Collapse
Affiliation(s)
- H R Haak
- Department of Endocrinology, University Hospital Leiden, The Netherlands
| | | | | | | |
Collapse
|
48
|
Hollander AA, Kluin-Nelemans HC, Haak HR, Stern AC, Willemze R, Fibbe WE. Correction of neutropenia associated with chronic lymphocytic leukaemia following treatment with granulocyte-macrophage colony-stimulating factor. Ann Hematol 1991; 62:32-4. [PMID: 2031965 DOI: 10.1007/bf01714981] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A patient with chronic lymphocytic leukaemia (CLL) and severe persisting neutropenia due to marrow infiltration of his leukaemia, developed bilateral Legionella pneumophila pneumonia for which he was treated with erythromycin, rifampin and ciprofloxacin. To increase the number of circulating polymorphonuclear neutrophils, the patient was treated with recombinant granulocyte-macrophage colony-stimulating factor (GM-CSF) at a dose of 2 micrograms protein/kg bodyweight s.c./12 h. GM-CSF therapy resulted in a sustained rise of the neutrophil count from the fifth day of treatment onwards, without showing an effect on the number of circulating leukemic cells. The patient completely recovered from his pneumonia. It is suggested that the rise of the neutrophil count, due to GM-CSF, contributed to the improvement of the infection of this patient. Our observation illustrates that GM-CSF can be given safely to CLL-patients and that it can be used effectively in CLL patients with severe bacterial infections to restore neutropenia.
Collapse
Affiliation(s)
- A A Hollander
- Department of Haematology, University Hospital Leiden, The Netherlands
| | | | | | | | | | | |
Collapse
|
49
|
|
50
|
|