Purpose Post-operative complications following fixation of pelvic fractures can lead to mortality and increased morbidity. Available literature regarding complications is heterogeneous and... Show morePurpose Post-operative complications following fixation of pelvic fractures can lead to mortality and increased morbidity. Available literature regarding complications is heterogeneous and knowledge on risk factors is limited. This study aims to identify the most common post-operative complications and their possible risk factors following pelvic fracture surgery. Methods A retrospective cohort study was performed in two level-1 trauma centers in the Netherlands between January 2015 and January 2021. Included patients were all adult patients (>= 18 years) with an operatively treated pelvic fracture (pelvic ring and/or acetabular fractures). Post-operative complications included surgical site infections (SSI), material-related complications, neurological complications, malunion/non-union and performed reoperations. A forward stepwise multivariable logistic regression analysis was used to identify any risk factors associated with these complications. Results Complications occurred in 55 (24%) of the 233 included patients. SSI's were most common, occurring in 34 (15%) patients. Duration of surgery (odds ratio 1.01 per minute, 95% confidence interval 1.00-1.01) and obesity (odds ratio 1.10 per BMI point, 95% confidence interval 1.29-7.52) were independent risk factors for development of SSI. Less common post-operative complications were material-related complications (8%) and neurological damage (5%). Conclusion Limiting operation time by using less invasive and less time-consuming surgical approaches may reduce the risk of SSI. More awareness and post-operative screening for early signs of SSI is mandatory, especially in obese patients. Future research should include large prospective patient cohorts to determine risk factors for other post-operative complications associated with pelvic fracture surgery. Show less
This thesis consists of studies on stereotactic radiotherapy (SRT) of intracranial tumors aiming at optimizing the treatment technique and improving the patients__ outcome. We compared two... Show moreThis thesis consists of studies on stereotactic radiotherapy (SRT) of intracranial tumors aiming at optimizing the treatment technique and improving the patients__ outcome. We compared two treatment planning techniques (dynamic conformal arc and intensity-modulated radiotherapy) and concluded that for most patients optimal plans were possible with both techniques. We also found that patient fixation during SRT could be improved by adding a vacuum mouthpiece to the standard stereotactic frame. Five chapters deal with treatment results of SRT in patients with brain metastases. From our own results and a literature review we concluded that single fraction SRT produces excellent local control results in patients with small brain metastases, but insufficient local control rates in patients with large metastases. The higher biologically equivalent doses needed for improved local control rates in large brain metastases can be administered with fractionated SRT. Finally, we studied the clinical problem of lesion growth after SRT of brain metastases. The cause can be real tumor progression or pseudo-progression (radiation toxicity). We found that symptomatic pseudo-progression is serious radiation toxicity of the normal brain tissue surrounding the metastasis. Reduction of pseudo-progression rates is possible by limiting the volume of normal brain tissue that receives high radiation doses. Show less
In dit proefschrift heb ik onderzocht wat de klinische waarde is van migratie van totale knie protheses (TKP) en totale heup protheses (THP) gemeten met Radiostereometrische Analyse (RSA)in de... Show moreIn dit proefschrift heb ik onderzocht wat de klinische waarde is van migratie van totale knie protheses (TKP) en totale heup protheses (THP) gemeten met Radiostereometrische Analyse (RSA)in de context van een gefaseerde klinische introductie. De studies in dit proefschrift tonen aan dat onveilige (hoog revisie percentage voor loslating) TKP en THP met RSA studies kunnen worden ge_dentificeerd in slechts 2 jaar follow-up. Vroege identificatie met RSA van deze onveilige TKP en THP voorkomt wijdverbreide gebruik. De gefaseerde klinische introductie van nieuwe implantaten op basis van RSA studies met 2 jaar follow-up kan leiden tot betere en veiligere pati_ntzorg en tot een reductie van de kosten in de zorg ten gevolge van revisie van TKP en THP. Follow-up in nationale implantaten registers is noodzakelijk om de resultaten van de implantaten te blijven vervolgen, nadat deze op de markt zijn gekomen. Show less
