http://repub.eur.nl/res/aut/9746/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/16841/ 2009-07-01T00:00:00Z SUMMARY BACKGROUND DATA: The role of early endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis (ABP) remains controversial. Previous studies have included only a relatively small number of patients with predicted severe ABP. We investigated the clinical effects of early ERCP in these patients. METHODS: We performed a prospective, observational multicenter study in 8 university medical centers and 7 major teaching hospitals. One hundred fifty-three patients with predicted severe ABP without cholangitis enrolled in a randomized multicenter trial on probiotic prophylaxis in acute pancreatitis were prospectively followed. Conservative treatment or ERCP within 72 hours after symptom onset (at discretion of the treating physician) were compared for complications and mortality. Patients without and with cholestasis (bilirubin: >2.3 mg/dL [40 μmol/L] and/or dilated common bile duct) were analyzed separately. RESULTS: Of the 153 patients, 81 (53%) underwent ERCP and 72 (47%) conservative treatment. Groups were highly comparable at baseline. Seventy-eight patients (51%) had cholestasis. In patients with cholestasis, ERCP (52/78 patients: 67%), as compared with conservative treatment, was associated with fewer complications (25% vs. 54%, P = 0.020, multivariate adjusted odds ratio [OR]: 0.35, 95% confidence interval [CI]: 0.13-0.99, P= 0.049). This included fewer patients with >30% pancreatic necrosis (8% vs. 31%, P = 0.010). Mortality was nonsignificantly lower after ERCP (6% vs. 15%, P = 0.213, multivariate adjusted OR: 0.44, 95% CI: 0.08-2.28, P = 0.330). In patients without cholestasis, ERCP (29/75 patients: 39%) was not associated with reduced complications (45% vs. 41%, P = 0.814, multivariate adjusted OR: 1.36; 95% CI: 0.49-3.76; P = 0.554) or mortality (14% vs. 17%, P = 0.754, multivariate adjusted OR: 0.78; 95% CI: 0.19-3.12, P = 0.734). CONCLUSIONS: Early ERCP is associated with fewer complications in predicted severe ABP if cholestasis is present. http://repub.eur.nl/res/pub/21860/ 2005-11-01T00:00:00Z http://repub.eur.nl/res/pub/21698/ 2005-06-01T00:00:00Z The pursuit of an African Renaissance has become an important aspect of regional cooperation between South Africa and its neighbours. Transfrontier conservation areas, or ‘Peace Parks’ as they are popularly called, have been identified as key instruments to promote the African Renaissance dream, and are increasingly advocated and justified on this basis. By fostering joint conservation (and tourism) development in Southern Africa’s marginalised border regions, Peace Parks are claimed to further international peace, regional cooperation and poverty reduction, and thus serve basic ideals of the African Renaissance. This article critically explores this assumption. Using the joint South African-Mozambican-Zimbabwean Great Limpopo Park as a case study, it argues that in reality the creation of Peace Parks hardly stimulates and possibly even undermines the realisation of the African Renaissance ideals of regional cooperation, emancipation, cultural reaffirmation, sustainable economic development and democratisation. So far, their achievement has been severely hindered by domination of national interests, insufficient community consultation, and sensitive border issues such as the illegal flows of goods and migrants between South Africa and neighbouring countries. Furthermore, exacerbation of inter-state differences induced by power imbalances in the region, and harmonisation of land use and legal systems across boundaries, are increasingly becoming sources of conflict and controversy. Some of these problems are so severe, we conclude, that they might eventually even undermine support for African Renaissance as a whole. Utmost care is thus required to optimally use the chances that Peace Parks do offer in furthering an African Renaissance. http://repub.eur.nl/res/pub/21710/ 2005-01-01T00:00:00Z From the fortress conservation paradigm in the 1960s and 1970s to the community based conservation paradigm of the 1980s and 1990s, the ideological linkage of people and conservation of natural resources in Africa seemed to have progressed towards local ownership and local management. At present, however, it looks as though the limits of community ownership over natural resources have been reached. According to powerful actors on the conservation scene, local people in Africa have not been able to effectively conserve their wildlife and biodiversity and thus – in their view - a more enforcing style of conservation, separated from local people, is needed again. Although this trend is still in its infancy, it is promoted with rigour and backed by substantial financial means. In this paper, we use the changing discourse in the environment-development nexus as a starting point to examine issues of governance and power over the conjunction of natural resources management and development in Southern Africa, with a special focus on the role of the state. By drawing on a case study whereby different states jointly try to manage the conservation-development nexus, here the case of the Great Limpopo Transfrontier Park between South Africa, Zimbabwe and Mozambique, we are able to better situate the role of the Southern African state within this nexus. We conclude that the way states are trying to govern transfrontier parks is not in par with the way processes of governance unfold themselves nowadays under the influence of the forces of globalisation and localisation. If Southern African states are to retain any control over the direction that the conservation-development nexus in Southern Africa will take in practice, they need to adapt to the current international governance climate, and they need to adapt fast. With Southern Africa’s history of enormous social disadvantages in relation to conservation, states just cannot afford to be bypassed by a resurgence of that same history. http://repub.eur.nl/res/pub/8559/ 1995-01-01T00:00:00Z A 71 year old man underwent retrosternal gastric tube reconstruction following transhiatal oesophagectomy for squamous cell carcinoma. On the second post-operative day, the patient developed a cardiac arythmia with secondary hypotension followed by hypoxaemia necessitating artificial ventilation. Two weeks after surgery, endoscopy revealed massive necrosis of the proximal segment of the gastric tube extending from the anastomosis in the neck to the watershed area. Three weeks later, the patient died and a necropsy was performed. Macroscopic evaluation of the gastric tube revealed a sharply demarcated and fully ossificated proximal segment. Heterotopic ossification was present on histological examination. This condition has only been described in conjunction with primary or metastatic gastric adenocarcinoma. The location of the ossification and the presence of temporary systemic hypoxia suggest that the latter was the main factor responsible for the ossificative response.