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Biomedical subjects

F W Hazebroek

Publications and source records attributed to F W Hazebroek.

At least 55 records · Page 3Linked to original sources
PubMed1990

Total parenteral nutrition associated cholestasis: a predisposing factor for sepsis in surgical neonates?

Of 496 neonates and infants less than 1 year of age admitted to the paediatric surgical intensive care unit (PSICU) over a 5 year period (1983-1987), 94 required total parenteral nutrition (TPN) for more than 14 consecutive days, generally due to congenital anomalies of the digestive tract. Cholestasis occurred in 15 of them and 12 of these patients developed sepsis. In contrast, of the 79 patients on TPN that remained free from cholestasis, only 23 developed sepsis. The mortality rate for the TPNAC-group was substantially higher than for the group without TPNAC. It is suggested that development of TPNAC might lead to impairment of non-specific cellular immunity in neonates.

Bacterial Infections↗
PubMed1990

Congenital diaphragmatic hernia: impact of prostanoids in the perioperative period.

A prospective study of 10 neonates with congenital diaphragmatic hernia and five controls to determine the importance of prostanoid concentrations perioperatively and the relation with persistent pulmonary hypertension (PPH) is reported. In neonates with congenital diaphragmatic hernia postoperative concentrations of the vasoconstrictor thromboxane B2 rose significantly and were higher during episodes of PPH; this rise may provoke PPH and subsequent right to left shunting.

6-Ketoprostaglandin F1 alpha↗
PubMed1989

Pre-operative stabilisation with delayed repair in congenital diaphragmatic hernia.

Congenital diaphragmatic hernia (CDH) remains one of the major challenges for paediatric surgeons and paediatric intensive care specialists. Death in patients with CDH is 30-60% worldwide due to severe pulmonary hypoplasia or pulmonary hypoplasia associated with persistent pulmonary hypertension, secondary to hypoxia, metabolic acidosis or myocardial insufficiency. Pre-operative stabilisation of CDH patients might reduce the risks of these complications. In a two-year period 16 high-risk patients with CDH (respiratory insufficiency less than 6 hrs after birth) underwent delayed surgery following a stabilisation period (mean 14 hrs). Continuous suctioning on a nasogastric tube resulted in total resolution of the mediastinal shift on repeat x-rays. The use of the ventilation parameters arterial alveolar oxygen gradient (A-aDO2), oxygenation index (OI) and mean airway pressure (MAP) revealed three different groups of patients: I consisting of 6 survivors, II two preventable deaths and III eight non-survivors. In this way selection of patients with CDH is possible. In patients who do not improve during the stabilisation period alternative ways of treatment have to be evaluated such as extracorporeal membrane oxygenation (ECMO), high frequency oscillation (HFO) or high frequency jet ventilation (HFJV). Application of the ventilation parameters in prospective trials of patients with CDH enables comparison between different ways of treatment in the future.

Blood Pressure↗
PubMed1989

Bowel resection in the neonatal phase of life: short-term and long-term consequences.

Bowel resection during the neonatal phase of life may be associated with considerable morbidity, both short- and long-term. A retrospective evaluation is reported, concerning 74 patients who underwent bowel resection over a ten-year-period, due to necrotising enterocolitis, atresia, volvulus or Hirschsprung's disease. The cause of death of 15 non-survivors was investigated and the pattern of morbidity of 59 surviving patients was evaluated regarding growth, nutrition and defaecation. It was concluded that the ultimate prognosis for most patients is good, despite considerable morbidity during the first year of life, involving serious losses of fluids and electrolytes, cholestasis, and recurrent sepsis due to central venous catheters.

Body Height↗
PubMed1989

Sinusitis: hidden source of sepsis in postoperative pediatric intensive care patients.

Paranasal sinusitis is reported as a complication of prolonged nasal intubation and the source of sepsis in adult intensive care patients. In surgical neonates with congenital malformations, prolonged intubation with a nasotracheal (NT) or NG tube is often necessary, but sinusitis with complicating sepsis is seldom reported. Sinus x-rays may confirm the diagnosis; in infancy, prolonged nasal intubation delays the pneumatization of the sinuses and the mastoids, resulting in additional diagnostic problems. In a 1-yr period, we saw three patients with multiple septic episodes in which the source of sepsis was undetectable. Despite the absence of clinical symptoms and radiologic evidence of sinusitis or mastoiditis, surgical drainage revealed pus and led to the disappearance of septic episodes and ear, nose, and throat problems. There is an association between prolonged NT and NG intubation, and sinusitis or mastoiditis as an unrecognized source of sepsis in young infants. Absence of radiologic evidence of sinusitis or mastoiditis causes pitfalls in diagnosis and is related to delayed pneumatization of the sinuses and the mastoid in prolonged nasal intubation in young infants.

Bacterial Infections↗
PubMed1988

Congenital diaphragmatic hernia: impact of preoperative stabilization. A prospective pilot study in 13 patients.

In case of congenital diaphragmatic hernia (CDH), survival generally depends not on prenatal diagnosis, planned delivery, and immediate postnatal operation, but on the gravity of pulmonary hypoplasia and persistent hypertension (PPH). Many vasoactive drugs have become available for lowering PPH, but the mortality rate for CDH still amounts to 40% to 70%. Preoperative stabilization might prevent or at least reduce the risk of PPH. This method was evaluated in a pilot study lasting 15 months and involving 13 patients. All were admitted to the pediatric surgical intensive care unit within six hours of birth, all requiring mechanical ventilation. Continuous suction of the stomach and bowel proved successful in reducing the mediastinal shift. Study parameters were alveolar-arterial oxygenation differences ((A-a)DO2), mean airway pressure (MAP), oxygenation index (OI), and ventilation index (VI), measured on admission and at set times before and after surgery. Eight patients did not survive, but in two cases death was not directly related to CDH. The following conclusions were reached: (1) satisfactory ventilation parameters on admission will remain good during the preoperative stabilization phase and will not be affected by its duration or by subsequent surgery, spelling survival; (2) unsatisfactory ventilation parameters on admission may improve with preoperative stabilization, giving these patients a better chance of survival; and (3) poor ventilation parameters on admission that fail to improve with preoperative stabilization will not improve with surgery or postoperatively, spelling death.

Female↗
PubMed1988

Hormonal evaluation of boys born with undescended testes during their first year of life.

We studied pituitary-gonadal function during the first year of life in 48 boys born with 56 undescended testes in order to test the hypotheses that functional insufficiency of the hypothalamo-pituitary-gonadal axis and disorders of testosterone (T) biosynthesis occur in such boys. Cryptorchidism persisted for longer than 1 yr in 29 boys (30 testes; group I), whereas spontaneous descent occurred in 19 boys (20 testes; group II), in 6 after the sixth month. A control group (group III) included 160 boys. Basal and peak LHRH-stimulated serum LH and FSH and basal serum T values were determined at 3, 6, and 12 months. Serum T, dihydrotestosterone (DHT), progesterone (P), 17-hydroxypregnenolone, 17-hydroxyprogesterone, dehydroepiandrosterone sulfate, and androstenedione before and after hCG administration were determined at age 1 yr. Comparing the 3 groups, cross-sectional evaluation revealed no significant differences in basal or peak LHRH-stimulated serum LH and FSH levels, except that basal serum LH levels were slightly higher in group II than in group III. Comparing groups I and II, longitudinal evaluation revealed similar basal and peak LHRH-stimulated serum LH and FSH values, with comparable changes with time. Basal serum T, DHT, and T precursor levels were similar in all three groups, with similar rises of T and DHT and variable minimal increases in androstenedione and dehydroepiandrosterone sulfate after hCG stimulation. We conclude that during the first year of life, boys with cryptorchidism have no functional insufficiency of the hypothalamo-pituitary-gonadal axis or disorders in T biosynthesis.

17-alpha-Hydroxyprogesterone↗
PubMed1987

"Acquired" congenital diaphragmatic hernia.

A case of late presentation of left congenital diaphragmatic hernia (CDH) in a boy of 9 months is reported. A chest X-ray taken after (premature) birth gave normal results; hence this type of CDH is called "acquired". Not being associated with pulmonary hypoplasia, this condition is difficult to diagnose. The patient presented as an emergency and the initial diagnosis was tension pneumothorax. This resulted in the insertion of a chest tube, fortunately without damage to the herniated stomach and spleen. Doubling upward of the tip of the nasogastric tube led to the correct diagnosis. After successful repair of the diaphragm the child made a full recovery.

Follow-Up Studies↗
PubMed1987

LH-RH nasal spray treatment for cryptorchidism. A double-blind, placebo-controlled study.

A double-blind, placebo-controlled study of the efficacy of LH-RH nasal spray in treatment of cryptorchidism involving 252 prepuberal boys with 301 undescended testes, showed a success rate of 9% (14 testes) for LH-RH and 8% (10 testes) for placebo. Including a subsequent open study and a second course of LH-RH as required, the rate for LH-RH rose to 18% (48 testes). The follow-up period saw late descent in another 5% (14 testes), in a few cases coinciding with the onset of puberty. Retrospective evaluation revealed a previous scrotal position of the testes for 43% of the boys with success of treatment and even for 17% of the boys with failure of treatment. In many of these cases surgery revealed an anatomical anomaly that might have caused testicular ascent. Hormonal evaluation revealed no abnormalities in cryptorchid boys compared with control subjects, nor was there a divergence in values before and after treatment. The lower the pretreatment testicular position, the better the rate of success.

Administration, Intranasal↗
PubMed1987

Why luteinizing-hormone-releasing-hormone nasal spray will not replace orchiopexy in the treatment of boys with undescended testes.

Two courses of LHRH nasal spray (400 micrograms three times a day for 28 days), partly administered in a double-blind placebo-controlled study, resulted in the descent of 48 of 281 testes (18%) in 237 prepuberal boys. Logistic regression analysis confirmed the clinical observation that pretreatment testicular position was the major factor influencing treatment results: the lower the pretreatment testicular position, the better the result. Of the unsuccessfully treated boys, 170 with 196 undescended testes subsequently underwent orchiopexy revealing anatomic anomalies that accounted for failure of hormonal treatment in 80% of the cases. Most frequent finding amounted to an underdeveloped processus vaginalis, extending no further than the level of the pubic bone, often associated with major epididymal deformities and a lack of obliteration of the processus vaginalis (107 of 196 operations). Obstruction of the scrotal entrance due to abnormal Scarpa's fascia or abnormal gubernacular remnant was found in 35 and testicular absence in 15 cases. LHRH nasal spray might be effective when the testis can be manipulated to at least the scrotal entrance before treatment, but in view of our surgical findings, LHRH nasal spray will not replace orchiopexy.

Administration, Intranasal↗
PubMed1987

[The non-scrotal testis].

In this article the classification of the nonscrotal testis is elucidated with a description of all forms of incomplete testicular descent. A great deal of attention is paid to the process of reaching the proper diagnosis, outlining the procedure for physical examination. The risk of infertility, the rather rare occurrence of testicular tumor, and a disturbance of the psychosexual development, are reasons why the undescended testis should be treated. How the undescended testis should be treated, hormonal or surgical, depends entirely on the position of the testis. LHRH nasal spray may induce descent in testes that have emerged from the inguinal canal and can be manipulated to at least the scrotal entrance. Surgical treatment is indicated for all undescended testes that have not emerged from the inguinal canal as well as all ectopic testes, and for those testes that failed to descend with hormonal therapy. The treatment protocol for all types of nonscrotal testes is discussed and schematically presented.

Child↗
PubMed1986

Double-blind, placebo-controlled study of luteinising-hormone-releasing-hormone nasal spray in treatment of undescended testes.

In a double-blind, placebo-controlled study, 252 prepubertal boys with 301 undescended testes were treated with luteinising-hormone-releasing-hormone (LHRH), 1.2 mg/day intranasally. After the 8-week double-blind period 10 placebo-treated (8%) and 14 LHRH-treated (9%) testes had completely descended. After a second LHRH course, involving all the subjects in an open study, 48 testes (18%) had descended completely. The lowest success rate (7%) occurred in the youngest age group (1-2 years). Of the successfully treated testes, 75% could be manipulated at least to the scrotal entrance before treatment. In comparison with age-matched controls, the cryptorchid boys' responses to LHRH and human chorionic gonadotropin before treatment did not suggest a deficient hypothalamo-pituitary-gonadal axis or deficient Leydig cell function. After treatment there was no evidence of stimulation of the hypothalamo-pituitary-gonadal axis; serum testosterone did not increase. Surgery was required in 170 patients (196 testes) revealing various anatomical anomalies.

Administration, Intranasal↗
PubMed1986

Histopathological investigation of duplications of the alimentary tract.

Lack of information on the morbid anatomy of duplications of the alimentary tract stimulated an evaluation of patients with such duplications seen at the Sophia Children's Hospital, Rotterdam, from 1970 to 1984. There were 14 patients in all, involving 2 foregut, 6 midgut, and 4 hindgut duplications. Resected material of 12 of these patients has been investigated with particular emphasis on the presence of nervous tissue in these duplications. Routine histological as well as histochemical staining procedures have revealed nervous tissue in practically all duplications investigated. Considering the findings reported in the literature with reference to the earliest manifestation of nerve cells throughout the alimentary tract, the results demonstrate that duplications occur well before the 12th week of gestation.

Autonomic Nervous System↗
PubMed1985

Gastroschisis associated with atresia--a plea for delay in resection.

Two cases of gastroschisis complicated by atresia and ischaemia of the small-bowel wall are presented. Full recovery of the intestine is shown to be feasible. Apparently the atrocious picture presented by the matted intestine upon birth does not reflect the true state of the deeper structures. A plea is made to delay resection and to perform a second look operation at a later stage in an effort to save intestinal length.

Abdominal Muscles↗