MRI-detected inflammation around the extensor tendons of metacarpophalangeal (MCP-) joints is prevalent in RA and poses a markedly increased risk of RA development when present in arthralgia... Show moreMRI-detected inflammation around the extensor tendons of metacarpophalangeal (MCP-) joints is prevalent in RA and poses a markedly increased risk of RA development when present in arthralgia patients. Such inflammation is called 'peritendinitis' since anatomy literature reports no presence of a tenosynovial sheath at these tendons. However, the presence or absence of tenosynovium at these extensor tendons has never been studied. Therefore, an anatomical and histological study of extensor tendons at the MCP-joints of three embalmed human hands was performed. Immunohistochemical staining showed the presence of markers for synovial macrophages and fibroblast-like synoviocytes bordering a natural dorsal space next to the extensor tendon, suggesting the presence of a synovial lining. This implies that contrast-enhancement on MRI around extensor tendons at MCP-joints observed in early RA and pre-RA likely represents tenosynovitis and that inflammation of this synovial tissue is an early feature of RA. Show less
With advancement of techniques in endourology, treatments for renal stones have increased possibilities. This thesis analyses existing surgical treatments, pain treatments and renal anatomy.
Rheumatoid arthritis (RA) is a disease of the synovium that involves the small joints of hands and feet. The focus in RA-research, however, has primarily been on involvement of the hands. In this... Show moreRheumatoid arthritis (RA) is a disease of the synovium that involves the small joints of hands and feet. The focus in RA-research, however, has primarily been on involvement of the hands. In this thesis we studied involvement of the forefoot. Throughout this thesis we found that synovitis in the rheumatoid foot affects more than just the joints. In an anatomic study we revealed that the tendon-sheaths in the forefoot also possess a synovial layer. Inflammation of this, detected by MRI that is referred to as tenosynovitis, was an important aspect of RA involvement in the forefoot. In addition, intermetatarsal bursae also detected by MRI are also often inflamed due to disease-involvement. These extra-articular involvements of the synovium that are found in RA importantly contribute to joint swelling and walking disability, and are therefore clinically relevant. Therefore we believe that it is essential for the clinician to pay attention to the forefeet of patients with RA to have a complete idea of disease activity Show less
Overactive bladder syndrome (OAB) is a common lower urinary tract disorder. So far, no therapy is beneficial and applicable for all OAB patients because patients with OAB represent a very... Show moreOveractive bladder syndrome (OAB) is a common lower urinary tract disorder. So far, no therapy is beneficial and applicable for all OAB patients because patients with OAB represent a very heterogeneous group of patients. Research has mainly focused on bladder function. recently the international continence society has called for research to urethral function within OAB. The aim of this thesis is to further elucidate the role of urethral function within OAB to contribute to better targeted therapy in patients with OAB. This thesis consists of seven chapters and contains the results of an anatomical study to the presence of adrenoceptor B3 in the human female urethra, a review of the literature on this subject, the results of a functional urodynamic study to assess the best method to demonstrate urethral pressure variations and the results of clinical urodynamic study to the effect of pharmacotherapy with adrenoceptor B3-agonist in patients with OAB and urethral pressure variations and finally the results of a pilot study to the efficacy of a localized treatment with botuline toxin-A treatment for patients with urethral pressure variations. Show less
In this thesis, I targeted the orchid genus Lepanthes, one of the six genera of angiosperms that surpasses 1,000 species in the Neotropics, as a study model to investigate the evolutionary... Show moreIn this thesis, I targeted the orchid genus Lepanthes, one of the six genera of angiosperms that surpasses 1,000 species in the Neotropics, as a study model to investigate the evolutionary processes that promoted species diversifications. To investigate this, we improved the taxonomy of the group integrating a solid phylogenetic framework with morphological evolution, assessing inter-specific relationships in species complexes with hundreds of DNA markers using anchored hybrid enrichment approach, and describing new species. In addition, we addressed the pollination of Trichosalpinx through the study of floral anatomy, pollinator behavior, and floral traits. Trichosalpinx flowers are pollinated exclusively by female biting midges that are attracted by the small quantities of proteins secreted on the flowers. Finally, we inferred the biogeographical history and diversification dynamics of the two largest Neotropical orchid groups (Cymbidieae and Pleurothallidinae), using densely sampled phylogenies coupled with geological datasets and discussed the impact of biogeographical events and orogeny on the species richness of Lepanthes. Species diversification is correlated with Andean orogeny, and multiple migrations and recolonizations across the Andes indicate that mountains do not constrain orchid dispersal over long timescales. This thesis provides new insights into the complex evolution of one of the most species-rich angiosperm. Show less
Over the last decade, there has been an exponential development in cardiac imaging technology. Currently, cardiac imaging plays a central role in clinical management and decision making in the... Show moreOver the last decade, there has been an exponential development in cardiac imaging technology. Currently, cardiac imaging plays a central role in clinical management and decision making in the diverse and growing population of patients encountered in daily cardiology practice. Important outcome-related parameters can be derived from these techniques, allowing better risk stratification of patients with ischemic heart disease. Still, the large amount of information provided by the different imaging modalities can be overwhelming and it can be challenging for the cardiologist to make optimal use of all information that is provided by the different modalities. The purpose of this thesis was to optimize the clinical usefulness of specific cardiac imaging modalities for particular patient categories, with the purpose of improving risk estimation in patients with suspected coronary artery disease, patients who suffered from STEMI and heart failure patients. Show less
In onze moderne tijd wordt aan het goed functioneren van infrastructuur grote aandacht besteed. In het hier gepresenteerde onderzoek heb ik getracht aan te tonen dat ook in de Grieks-Romeinse... Show moreIn onze moderne tijd wordt aan het goed functioneren van infrastructuur grote aandacht besteed. In het hier gepresenteerde onderzoek heb ik getracht aan te tonen dat ook in de Grieks-Romeinse wereld de doorstroming als een cruciaal punt werd beschouwd. Niet alleen de infrastructuur zelf, ook datgene wat via de infrastructuur wordt getransporteerd moet aan hoge kwaliteitseisen voldoen om de (Grieks-Romeinse) stad leefbaar te houden. Evenals tegenwoordig werd ook in de Grieks-Romeinse wereld het functioneren van een stad of gebied soms vergeleken met een menselijk lichaam. In beide gevallen is sprake van voedsel- en drinkwatervoorziening, uitscheiding van afvalproducten en een interne infrastructuur die de producten naar en van hun plaats moet brengen en als zodanig de stad c.q. het lichaam in stand moet houden. Wanneer de infrastructuur echter niet meer kan functioneren __ te weinig capaciteit, een onderbreking of een verkeerde inhoud __ komt de doorstroming in gevaar en lopen lichaam en stad de kans ziek te worden met uiteindelijk de dood als gevolg. De infrastructuur m__t in bedrijf zijn en blijven. Stadsbesturen zagen in dat iedereen baat had bij een goed functionerende stad en troffen voorzieningen om de leefbaarheid van een stad te optimaliseren. Show less
A description of 17th century anatomical activity at the major Dutch university in a cultural context This study offers a history of the Leiden anatomical theatre in the first century of its... Show moreA description of 17th century anatomical activity at the major Dutch university in a cultural context This study offers a history of the Leiden anatomical theatre in the first century of its existence; who were the scientists working there in the 17th century, the Dutch Golden Age. What was the motivation of these scholars for studying and demonstrating the human body? Was it purely medical or were their other - more philosophical - questions at stake? Besides a cultural historical account of the anatomical theatre the dissertation also offers the histories of other centres of anatomical activity in 17th century Leiden: the Collegium Medico Practicum at the Caecilia Hospital, and Leiden's surgeons guild. Show less
