Vascular protective effect of aspirin and rivaroxaban upon endothelial denudation of the mouse carotid artery.

While in recent trials the dual pathway inhibition with aspirin plus rivaroxaban has shown to be efficacious in patients with atherosclerotic cardiovascular disease, little is known about the effects of this combination treatment on thrombus formation and vascular remodelling upon vascular damage. The aim of this study was to examine the effects of aspirin and/or rivaroxaban on injury-induced murine arterial thrombus formation in vivo and in vitro, vessel-wall remodelling, and platelet-leukocyte aggregates. Temporary ligation of the carotid artery of C57BL/6 mice, fed a western type diet, led to endothelial denudation and sub-occlusive thrombus formation. At the site of ligation, the vessel wall stiffened and the intima-media thickened. Aspirin treatment antagonized vascular stiffening and rivaroxaban treatment led to a positive trend towards reduced stiffening. Local intima-media thickening was antagonized by both aspirin or rivaroxaban treatment. Platelet-leukocyte aggregates and the number of platelets per leukocyte were reduced in aspirin and/or rivaroxaban treatment groups. Furthermore, rivaroxaban restricted thrombus growth and height in vitro. In sum, this study shows vascular protective effects of aspirin and rivaroxaban, upon vascular injury of the mouse artery.

High prevalence of reduced thrombin generation and/or decreased platelet response in women with unexplained heavy menstrual bleeding.

INTRODUCTION: Heavy menstrual bleeding (HMB) is a condition that affects 20%-30% of women of reproductive age. HMB has a multifactorial pathophysiology, which is incompletely understood. HMB symptoms are very common in patients with established haemostasis defects, likewise, women with heavy menstrual bleeding have a higher prevalence of impaired Von Willebrand factor (VWF) levels and function, thrombocytopenia, impaired platelet function and impaired coagulation. The aim of this study was to quantify the prevalence of impaired platelet function, impaired coagulation and reduced VWF activity in patients with HMB. METHODS: We have used thrombin generation (TG), a flow cytometry-based platelet function test and a flow cytometry-based VWF function test to study haemostasis in 58 women (median age: 48.4 years, range 40-60 years) with HMB. In addition, we determined VWF antigen levels and VWF ristocetin co-factor activity in platelet-poor plasma. Reference ranges of platelet function were measured in whole blood of 123 healthy volunteers, while reference ranges of TG were determined in platelet-poor plasma (PPP) of 126 healthy volunteers. RESULTS: Fourteen (24%) patients with HMB had impaired platelet function and 17 (29.3%) patients had impaired coagulation. Five patients (8.6%) had both impaired platelet function and impaired coagulation. Only 2 (3.4%) patients had an impaired VWF function or levels; one of them was in combination with impaired coagulation. CONCLUSION: Our approach in women with HMB using a high precision platelet function test in combination with thrombin generation showed impaired coagulation or impaired platelet function in more than 40% of the patients.

Incidence of hantavirus infections in Belgium.

Over the last two decades, and from the moment that serological detection was possible, human hantavirus infections have been documented in most European countries. This paper summarises the available data on hantavirus cases in Belgium. These data enable the demonstration of the existence of a 3-year epidemic cycle in Belgium, which is apparently linked to rodent population dynamics.

Diagnosis and treatment of malignant pheochromocytoma with 131I-meta-iodobenzylguanidine: a case report.

The case of a 67-year-old male patient with metastatic malignant pheochromocytoma is described to illustrate the significant improvement of the diagnosis and treatment of pheochromocytoma since the recent introduction of 131I-meta-iodobenzylguanidine (131I-MIBG). Because of the generally observed tumor heterogeneity as to 131I-MIBG uptake and radiosensitivity in advanced disease, treatment results may be improved further, if 131I-MIBG therapy is initiated when tumor load is still small.

Functional anatomy of the soft tissues of the hand and wrist: in vivo excursion measurement of the flexor pollicis longus-tendon using MRI.

Magnetic resonance imaging (MRI) of the flexor pollicis longus-tendon (FPL-tendon) with the thumb in different positions allows the in vivo assessment of its abduction-adduction/flexion excursion. Measurements can also be performed in different positions of the wrist. In our study, the mean excursion amplitudes of the FPL-tendon in seven healthy volunteers were 2.6 (+/- 0.26), 2.6 (+/- 0.25), and 2.7 (+/- 0.63) cm for neutral position, ulnar, and radial deviation of the wrist, respectively. The contribution of the abduction-neutral position route and the neutral position-adduction/flexion route to the total excursion of the thumb varied for the different positions of the wrist, despite the equal excursion amplitudes. The possibility of visualization and the accurate determination of the FPL-tendon excursions is of use in the reconstruction and the transposition of the FPL-tendon. In addition, the shift of the FPL-tendon can be visualized for different positions of the thumb and the wrist.

The effects of chemonucleolysis as demonstrated by computerised tomography.

Computerised tomography (CT) was performed in 30 patients with herniated lumbar discs; this was done both before chemonucleolysis and three months after. In 20 of the 28 patients who were CT positive, the compression produced by the herniated disc was eliminated or reduced. Twenty-three of the 28 patients developed diffuse bulging of the annulus. There was good correlation between the clinical results at three months and the alteration in compression as shown by the CT scan. No evidence of alteration in the bony relationship was seen in the scan and none of the patients developed epidural fibrosis. Chemonucleolysis has thus been shown to be an effective treatment of herniated lumbar discs, but it is definitely not indicated in cases where compression of the nerve root or dural sac is due to a bulging annulus.

[Hospital admission of nursing home patients considered but not carried out: role of the nursing home physician and the involved parties and various differences with realized hospital admissions]. / Ziekenhuisopname van verpleeghuispatiënten overwogen doch niet gerealiseerd: de rol van de verpleeghuisarts en de overlegpartijen en enkele verschillen met wel gerealiseerde ziekenhuisopnamen.

The objective of the study was to establish in which way nursing home patients, for whom is refrained from hospitalization, differ from hospitalized nursing home patients. The question was also raised of how the decision to refrain from hospitalization is taken: which point of view and method the nursing home physician has, on which arguments decisions are based and which parties are involved and in which way. The design of the study was retrospective and descriptive. Data obtained from semi-structured interviews held in 1987 with 24 nursing home physicians on 45 situations were compared with registration data on 387 hospitalizations of patients from 30 nursing homes. In the non-hospitalized patients malignancies were relatively more frequent than in the hospitalized patients (29% versus 7%). The mean age of hospitalized patients was 78 and of non-hospitalized patients 80 years. The physical condition of non-hospitalized patients was more frequently judged as poor and the life expectancy as more limited. Already at an early stage nursing home physicians appeared to have a point of view, with which they determined the decision making procedure: in favour of (40%), opposing (35%) and in doubt of hospitalization (25%). In 'non-hospitalizations' there was much more involvement in decision making of family members and nurses, and less involvement of patients and medical specialists than in decisions to hospitalization. Non-medical arguments opposing hospitalization had slightly the upper hand above medical arguments. The decisive arguments opposing hospitalization were in the case of psychogeriatric patients more often of medical origin than in the case of somatic patients. The 'quality of live' mentioned arguments were of limited importance. The nursing home physician needs good communicative qualities in such decision making processes. He has to be skilled to judge competency of patients and, if needed, to balance in the right way the information of relatives, nurses, colleagues and specialists.

[Long-term results of the Swanson prosthesis for the treatment of lunate osteomalacia]. / Lange-termijnresultaten van de Swanson-prothese ter behandeling van lunatomalacie.

From 1972 to 1982 a silicone implant arthroplasty was performed in 18 patients with Kienböck's disease grade III. In May 1988 all patients had a clinical and radiological re-examination. In the course of time reoperations were performed in 4 patients because of (sub)luxation of the prosthesis. Because of this operation most of the patients had less pain and retained an acceptable function of the wrist. Influence on working circumstances had been considerable in 8 patients. One patient received a disability pension because of this disease. Radiological examination often revealed increased degenerative changes in carpo-radial and intercarpal joints as well as proximal migration of the capitate. There was no clear relationship between residual complaints and function at the follow-up examination and the radiological findings.

[Pyomyositis, not an exclusively tropical disease]. / Pyomyositis, niet alleen een tropische ziekte.

Pyomyositis is considered to be limited to tropical areas. In recent years, however, it is increasingly reported from temperate climate areas, predominantly in immunocompromised patients. Since the disease can mimic several other conditions, it may remain unrecognized for weeks. Two native patients from the Netherlands are presented, neither of them had ever travelled to the tropics. One of the patients had AIDS, the other had no predisposing factors. Pyomyositis can be difficult to diagnose, but in most cases it is easy to cure. Pyomyositis should be considered in the differential diagnosis in patients with fever and localised myalgia.

[Value of proton spin tomography in the diagnosis of intra-articular pathological disorders of the knee]. / De waarde van kernspinresonantie-tomografie bij de diagnostiek van intra-articulaire pathologische afwijkingen van de knie.

Magnetic resonance imaging (MRI) of the knee was performed in 50 patients with unilateral knee problems with clinical suspicion of a meniscal tear or degeneration of the cartilage. The findings of the MRI examination were compared with previously performed arthrography and the diagnosis was subsequent confirmed arthroscopically. MRI detected degenerative changes in 69 out of 100 menisci and signs of a meniscal tear in 31 of the menisci. The diagnostic accuracy of MRI for a tear in the medial or the lateral meniscus was 91%. MRI was accurate in the detection of 8/11 ruptures of the anterior cruciate ligament and in 6/13 cases with degenerative changes of the patella.

[Hospital admission of nursing home patients: patient characteristics and purpose of admission]. / Ziekenhuisopnamen van verpleeghuispatiënten: patiëntenkenmerken en doel van opname.

OBJECTIVE: To establish how many hospitalisations of nursing home patients are realised annually, the characteristics of these patients and the diagnoses and the purposes for which they are hospitalised. DESIGN: Retrospective and prospective. METHOD: Analysis of national data for the 5-year period 1986-1990 obtained from the registration of nursing home patients (SIVIS) of the Dutch Centre of Health Care information (SIG) and analysis of 385 separately gathered registration data from 30 nursing homes. RESULTS: More than 9000 hospitalisations of nursing home patients were realised annually, over 10% of those who stay in a nursing home for a shorter or longer time. Somatic patients were hospitalised nearly twice as often as psychogeriatric patients, and men about 1.25 times more often than women. The probability of hospitalisation decreased with advancing age. The most frequent reasons for hospitalisation were cardiovascular diseases, digestive tract diseases and femoral neck fractures. The most important purposes of hospitalisation are: to ward off threat to life (31%), to remedy complaints and burdens (29%), to improve the general condition (16%) and diagnostics (16%). The probability of hospitalisation was 2.5 times as large for the elderly living at home as for older nursing home patients. CONCLUSIONS: Hospitalisations are an important part of medical treatment and care of nursing home patients. There is a variation in hospitalisation rates for different categories of patients. Objectives of hospitalisation are diverse. There is a need for research into the effects of hospitalisation on the quality of life.

[Who decides on hospital admission of nursing home patients?]. / Wie beslist over ziekenhuisopname van verpleeghuispatiënten?

OBJECTIVE: To examine how the decision making to hospitalize nursing home patients proceeds, who takes the initiative, which participants are involved and how much time the consultation and decision making take. DESIGN: Prospective. METHOD: Analysis of registration data about decisions to hospitalize nursing home patients, collected from nursing home physicians in 30 nursing homes. RESULTS: In 76% of the cases the nursing home physician took the initiative to hospitalize. 38% of the patients had been consulted, which influenced the decision. 22% of the patients did not participate in the decision, mostly because of poor mental condition. Consultation of family members and nurses compensated only partly for this limited consultation of patients. With the other patients there had been contact, but without influence on the decision. Medical specialists to nursing home physicians were the most important participants in the decision making. Over 40% of the decisions were taken within 1 h, almost 25% between 1 h and 1 day. The duration of the decision making and the possibilities for consultation were mostly dependent of the urgency of hospitalisation. CONCLUSIONS: Because of the limited possibilities for consultation of nursing home patients when hospitalisation is considered, it is important to anticipate early on such situations by discussing this with patients and family members, and to write down the patients' wishes.

[Hospital admission of nursing home patients: a difficult decision?]. / Ziekenhuisopname van verpleeghuispatiënten: een moeilijke beslissing?

OBJECTIVE: To examine how difficult decisions to hospitalize nursing home patients are considered by the physicians and to what patient characteristics this is related. DESIGN: Prospective and descriptive. METHOD: Analysis of registration data about 387 decisions to hospitalize nursing home patients collected among nursing home physicians in 30 nursing homes. RESULTS: The degree of difficulty of hospitalisation was associated primarily with poor physical condition and much less with the mental condition. It was not related to patient age (apart from physical condition and the reason for hospitalisation). Referrals were difficult for e.g. infections and respiratory tract disorders, which may be further complicated by the short time available for the decision making because of the life threatening nature of the disorders. With malignancies, feeding, urogenital and skin disorders, decisions to hospitalize also proved difficult to make. These disorders usually allowed more time for consultation. CONCLUSION: About half the decisions to hospitalize were considered hard to make. Only when there is better insight into the effects of hospitalisation on patient functioning and quality of life will it be possible to determine correctness and professional obviousness of such decisions.