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Biomedical subjects

J Gerritsen

Publications and source records attributed to J Gerritsen.

At least 73 records · Page 4Linked to original sources
PubMed1996

Cost of care of patients with cystic fibrosis in The Netherlands in 1990-1.

BACKGROUND: Research on the cost of care of patients with cystic fibrosis is scarce. The aim of this study was to estimate the costs using age-specific medical consumption from real patient data. METHODS: The age-specific medical consumption of patients with cystic fibrosis in The Netherlands in 1991 was estimated from a survey of medical records and a patient questionnaire. A distinction was made between costs of hospital care, hospital and non-hospital medication, and home care. Costs per year were obtained by multiplying the yearly amount of care and the costs per unit. RESULTS: On average the annual cost of a patient with cystic fibrosis in 1991 was 10,908 pounds (hospital care 42%, medication 37%, home care 20%). The cost of care of cystic fibrosis in The Netherlands, with approximately 1000 patients, is estimated at 10.9 million pounds per year, which is 0.07% of the total health care budget. The cost of care of a patient up to the age of 35 is estimated at 614,587 pounds. When year-to-year survival is taken into account and future costs are discounted to the year of birth with a yearly discount rate of 5%, the cost of care of a patient with cystic fibrosis is estimated at 164,365 pounds for 1991. This estimate will be used in a prospective evaluation of screening for cystic fibrosis carriers. CONCLUSIONS: The cost of care of patients with cystic fibrosis estimated by age-specific medical consumption of real patients is higher than that estimated by non-age-specific medical consumption and/or expert opinions.

Adolescent↗
PubMed1996

Use of tracheal auscultation for the assessment of bronchial responsiveness in asthmatic children.

BACKGROUND: It can be difficult to assess bronchial responsiveness in children because of their inability to perform spirometric tests reliably. In bronchial challenges lung sounds could be used to detect the required 20% fall in the forced expiratory volume in one second (FEV1). A study was undertaken to determine whether a change in lung sounds corresponded with a 20% fall in FEV1 after methacholine challenge, and whether the occurrence of wheeze was the most important change. METHODS: Fifteen children with asthma (eight boys) of mean age 10.8 years (range 8-15) were studied. All had normal chest auscultation before the methacholine challenge test. Lung sounds were recorded over the trachea for one minute and stored on tape. They were analysed directly and also scored blindly from the tape recording by a second investigator. Wheeze, cough, increase in respiratory rate, and prolonged expiration were assessed. RESULTS: The total cumulative methacholine dose causing a fall in FEV1 of 20% or more (PD20) was detected in 12 children by a change in lung sounds - in four by wheeze and in eight by cough, increased respiratory rate, and/or prolonged expiration. In two subjects altered lung sounds were detectable one dose step before PD20 was reached. In three cases in whom no fall in FEV1 occurred, no change in lung sounds could be detected at the highest methacholine dose. CONCLUSION: Changes in lung sounds correspond well with a 20% fall in FEV1 after methacholine challenge. Wheeze is an insensitive indicator for assessing bronchial responsiveness. Cough, increase in respiratory rate, and prolonged expiration occurs more frequently.

Adolescent↗
PubMed1996

Surfactant nebulization does not alter airflow obstruction and bronchial responsiveness to histamine in asthmatic children.

To test the hypothesis that surfactant nebulization improves pulmonary function and reduces bronchial responsiveness to histamine, we studied 12 children with asthma. We measured before and after inhalation of 100 mg nebulized natural-derived bovine surfactant (Alveofact (registered)) and after nebulization of 0.9% NaCl the change in peak expiratory flow, vital VC, FEV1, and forced expiratory flows at 50 and 75% of the flow-volume curve. In addition, we performed a histamine inhalation challenge. We did not find any significant changes in these parameters after nebulization of surfactant. These findings indicate that the inhalation of nebulized surfactant does not alter airflow obstruction and does not alter bronchial responsiveness to histamine in asthmatic children with airflow obstruction.

Adolescent↗
PubMed1996

Fluticasone propionate in children with moderate asthma.

Inhaled corticosteroids are considered to be effective and safe to treat children with asthma. These drugs, often used as maintenance treatment, can, however, influence the HPA-axis, which might be reflected by the serum and urine cortisol concentration. The aim of the present study was to investigate the efficacy and safety of fluticasone propionate (FP) 100 microg administered twice a day via a Diskhaler for 3 mo. FP was tested in a double-blind randomized placebo-controlled parallel trial in a group of 34 children with moderate asthma who did not use inhaled steroids for at least 4 wk prior to the study. At home, symptoms and peak flow recordings (PEFR) were noted in a diary. At each visit lung function was measured, and serum and urinary cortisol were determined. During treatment, wheezing decreased and PEFR values increased in the FP group. FEV1 and PC20-histamine increased and the reversibility decreased in the FP group. All changes were significant, with the exception of the change in nocturnal PEFR. Four weeks after cessation of FP all parameters returned to pretreatment values. Serum cortisol did not change significantly in either treatment group. The decrease in urinary cortisol in the FP group was significant only if it was compared with the increase in urinary cortisol in the placebo group. We conclude that FP 100 microg given twice a day is effective in children with moderate stable asthma. Suppression of the HPA-axis by FP 100 microg given twice daily, although not likely, cannot be ruled out by this study since the absence of a significant decrease in urinary cortisol in the FP group could be due to an insufficient number of patients. Additional studies are required to solve this problem.

Administration, Inhalation↗
PubMed1996

The nonhospital costs of care of patients with CF in The Netherlands: results of a questionnaire.

Cystic fibrosis (CF) causes a relatively high medical consumption. A large part of the treatment takes place at home. Because data regarding nonhospital care are lacking, we wished to determine the costs of care of patients with CF outside the hospital. A questionnaire was sent to 73 patients with CF from two Dutch hospitals (response rate 64%, 14 children and 33 adults). Average consumption and average costs per patient per year were calculated for children and adults for six categories: nonhospital medical care; domestic help; diet; travelling because of CF; medication; and devices and special facilities at home, work or school. The average nonhospital costs of care amounted to Pounds 4,641 per child per year (range Pounds 712-13,269) and Pounds 10,242 per adult (range Pounds 1,653-26,571). Nonhospital medical care for children and adults accounted for, respectively, 8 and 5% of these costs, domestic help for 15 and 9%, diet for 10 and 7%, travelling because of CF for 4 and 8%, medication for 63 and 67%, and devices and special facilities at home, work or school for 1 and 4%. Nonhospital costs of care of cystic fibrosis are very high and amount to 50% of the total (medical and nonmedical) lifetime costs of cystic fibrosis.

Absenteeism↗
PubMed1996

Eosinophils and eosinophil-derived proteins in children with moderate asthma.

Laboratory parameters can contribute to the diagnosis of asthma, which is often a difficult procedure in paediatric patients. The aim of this study was to investigate the value of eosinophil cationic protein (ECP) and eosinophil-derived neurotoxin (EDN) in the diagnosis of paediatric asthma. The number of eosinophils, serum ECP and EDN, and urinary EDN were determined in 22 children with stable, allergic asthma, aged 4-14 yrs, and in 17 age-matched healthy controls. Symptoms were monitored, the peak expiratory flow rate (PEFR) was recorded in the younger children, and lung function tests (forced expiratory volume in one second (FEV1) and the provocative concentration of histamine causing a 20% fall in FEV1 (PC20)) were performed in the older children. None of the asthmatic children had respiratory symptoms. PEFR was not significantly different in asthmatic children compared to controls. The FEV1 % predicted was significantly lower compared to controls. The number of eosinophils, serum ECP and EDN, and urinary EDN were significantly higher in asthmatic children compared with controls. After correction of serum ECP and EDN, and urinary EDN for the number of eosinophils, the differences between patients and controls disappeared. The nocturnal PEFR and the FEV1 were significantly related to urinary EDN. The results suggest that serum and urinary concentration of eosinophil-derived proteins can be determined instead of the number of eosinophils to support the diagnosis of asthma in childhood. The urinary concentration of eosinophil-derived neurotoxin can be especially valuable in young children, because in this age group quantification of lung function cannot be performed and blood sampling can be difficulty.

Adolescent↗
PubMed1996

Long-term outcome of early childhood wheezing: population data.

The adult prognosis of early childhood wheezing is reviewed using data from three studies (in Melbourne, Tasmania and Britain) which have followed population-based samples of 7 year old children with a history of asthma or wheezing illness into their early thirties. About one quarter of these wheezy children, recruited in the 1960s, reported recent wheeze as adults, but there was considerable variation in the severity of adult wheezing in the three studies. A pattern of remissions and relapses was common over approximately 25 yrs of follow-up. Thus, teenagers who appeared to have outgrown an earlier wheezing tendency remained at risk of future wheezing, particularly if they took up cigarette smoking. Adults who have outgrown their childhood wheezing tendency have ventilatory function similar to healthy controls, suggesting that the abnormalities of neonatal airway function which precede transient wheezing in early childhood do not predict adult obstructive lung disease. In contrast, asthmatic children who continue to wheeze as adults have poorer baseline spirometry than healthy controls, even after inhaled salbutamol. The degree of reduction correlates with the duration and persistence of wheezing. Bronchial hyperresponsiveness and reduced levels of ventilatory function in childhood predict both persistence of wheeze and level of bronchial responsiveness in adult life. These may simply be markers of disease severity, but there is evidence of progressive deterioration of ventilatory function through adolescence in children with persistent symptoms. These progressive changes may underlie the observed association between chest illness in childhood and later adult life.

Adult↗
PubMed1995

Frequency of nocturnal symptoms in asthmatic children attending a hospital out-patient clinic.

Since nocturnal symptoms indicate more severe asthma, we investigated their frequency in a hospital-based population of asthmatic children. Recognition of these symptoms offers the possibility to introduce appropriate treatment. We studied 796 consecutive children with asthma (mean (SD) age 9 (4) yrs) attending a hospital clinic, to determine whether these nocturnal symptoms predicted that daytime activities would be affected, and also the patients' perception of disease severity. At the end of a regular out-patient clinic visit, the answers to seven different questions concerning nocturnal symptoms in the previous 3 weeks were recorded. The forced expiratory volume in one second (FEV1) was > or = 90% predicted in 98% of the population that was able to perform lung function measurements (72% of the total population). In 38% of the patients with nocturnal symptoms, these symptoms were reported spontaneously. When asked for, nocturnal symptoms were reported by 47% of the children; 6% every night and 34% at least once a week. Cough was the most frequently reported symptom (31%). Children with nocturnal symptoms had a lower FEV1, scored their perception of asthma as more severe, and had their daytime activities affected more than those without nocturnal symptoms. Doctors should specifically ask about nocturnal symptoms, as not all patients with nocturnal symptoms report them spontaneously and they predict more severe disease.

Adolescent↗
PubMed1994

[Fatal chickenpox infection in a newborn infant].

A fatal disseminated varicella zoster infection was diagnosed in a newborn boy. The mother had contracted chickenpox 1 day before delivery. Infants whose mothers suffer from chickenpox between 5 days before and 2 days after delivery, should receive varicella zoster immunoglobulin immediately post partum. If clinical symptoms still occur, aciclovir should be administered.

Chickenpox↗
PubMed1994

Induction of low density and up-regulation of CD11b expression of neutrophils and eosinophils by dextran sedimentation and centrifugation.

Neutrophils and eosinophils circulating in an activated state are of low density. However, purification procedures such as dextran sedimentation and centrifugation may influence the density and function of cells. In the present study we have evaluated the effect of dextran sedimentation and subsequent centrifugation on the density and CD11b expression of neutrophils and eosinophils. Direct density separation of whole blood resulted in 17.7 +/- 9.0% low density neutrophils (< 1.090 g/ml) and 8.7 +/- 3.5% low density eosinophils (< 1.093 g/ml). Dextran sedimentation at room temperature prior to density separation yielded 57.8 +/- 14.7% low density neutrophils and 43.2 +/- 8.0% of low density eosinophils. Additional centrifugation after dextran sedimentation resulted in an increase of these numbers to 91.7 +/- 3.1 and 69.8 +/- 11.7% respectively. The density shifts were found with hypertonic as well as isotonic Percoll. Furthermore, it was shown that dextran sedimentation resulted in an increased CD11b expression on neutrophils as well as eosinophils. During subsequent washing by centrifugation, a further increase in CD11b expression was observed together with lactoferrin release. The effects of dextran sedimentation on density and CD11b expression were independent of extracellular calcium. These results indicate that dextran sedimentation induces the release of specific granule compartments with subsequent expression of CD11b, resulting in changes in granulocyte density.

Cell Fractionation↗
PubMed1994

Follow-up of asthma from childhood to adulthood: influence of potential childhood risk factors on the outcome of pulmonary function and bronchial responsiveness in adulthood.

The outcome of asthma in 406 children, aged 8 to 12 years, was studied. Follow-up in adulthood was 86%, with a mean age of 24.7 years and a mean interval of follow-up of 14.8 years. The predictive value of gender and various childhood variables on the adult level of pulmonary function (forced expiratory volume in 1 second [FEV1]) and bronchial responsiveness in adulthood was assessed. An increase in mean percent predicted FEV1 from childhood to adulthood was found, both in subjects with (76%) and without (24%) current respiratory symptoms. The only childhood variable predictive of adult level of FEV1 was the level of percent predicted FEV1 (p < 0.01). The proportion of subjects with a histamine provocative concentration causing a 10% decrease in FEV1 less than or equal to 16 mg/ml decreased significantly in adulthood. The degree of bronchial responsiveness had increased slightly in adults with symptoms (p = 0.87), whereas it had decreased significantly in subjects without symptoms (p < 0.01). Female subjects were significantly more responsive in adulthood than male subjects (p = 0.047). The childhood degree of bronchial responsiveness significantly predicted the presence of bronchial responsiveness in adulthood (p = 0.02). We conclude that childhood percent predicted FEV1 is relevant to predict the outcome of the adult pulmonary function level, whereas female gender and the childhood degree of bronchial responsiveness are important for the prediction of adult degree of bronchial responsiveness among children with asthma.

Asthma↗
PubMed1994

Dextran sedimentation induces a difference in the percentage of hypodense eosinophils in peripheral blood between children with allergic asthma and healthy controls.

Considerable differences in the percentage of hypodense eosinophils in the peripheral blood of asthmatics have been reported by different investigators. In these previous studies dextran sedimentation was used for removal of erythrocytes prior to density centrifugation. We hypothesized that the sedimentation procedure might induce the presence of hypodense eosinophils in the peripheral blood of asthmatic patients. In order to test this hypothesis, we compared eosinophil density profiles from peripheral blood of children with asthma and of age-matched healthy controls, using different procedures. In the first method (direct method) blood samples were directly layered on a discontinuous Percoll gradient. Erythrocytes were removed by isotonic lysis. In the second method (dextran sedimentation) erythrocytes were removed by sedimentation with dextran prior to gradient centrifugation. Results of the direct method show no significant difference in percentage of hypodense eosinophils between children with asthma and healthy controls (9.19% and 6.84% respectively). However, after dextran sedimentation, children with asthma had a significantly higher percentage of hypodense eosinophils than healthy controls (15.40% and 8.84% respectively; P < 0.05). The percentage of hypodense eosinophils was correlated with the number of eosinophils and with the lung function, measured as the Tiffeneau index (FEV1/VC), in the whole group of subjects when the direct method was used. We conclude that an increased percentage of hypodense eosinophils is not present in the circulation of children with asthma, but can be induced in vitro by dextran sedimentation. Therefore, in vitro generation of hypodense eosinophils in the blood of patients with asthma seems to be related with the primed state of eosinophils.

Adolescent↗
PubMed1994

Thyroxine and 3,5,3'-triiodothyronine production, metabolism, and distribution in pregnant rat near term.

In the pregnant rat near term thyroxine (T4) and 3,5,3'-triiodothyronine (T3) concentrations are lower in plasma and extrathyroidal tissues, except T3 in the brain. To study the changes in T4 and T3 kinetics a bolus injection of [125I]T4 and [131I]T3 was administered to nonpregnant controls and rats 14 and 19 days pregnant. Physiological parameters of the production, interpool transport, distribution, and metabolism of T4 and T3 were estimated by means of a three-compartment model. The production and partition of T4 remained unchanged during pregnancy. The total distribution volume of T4 was enlarged. On day 19 the plasma clearance rate was doubled, and transport to the fast pool was more than tripled. The rate of production of T3 was slightly diminished. The plasma clearance rate was increased, but no changes were found in the interpool transport rates. These results suggest that in the pregnant rat near term the increased transport of T4 is responsible for the distribution of the available T4 between the maternal and the fetal compartment.

Animals↗
PubMed1993

Expression of CD35 (CR1) and CD11b (CR3) on circulating neutrophils and eosinophils from allergic asthmatic children.

Complement receptors on neutrophils and eosinophils play a role in activation and adhesion. During asthmatic reactions these receptors have been found elevated on circulating granulocytes. In the present study we compared the expression of CD35 (complement receptor type 1) and CD11b (complement receptor type 3) on neutrophils and eosinophils from asthmatic and non-asthmatic children. This was done in whole blood samples using depolarized light scattering for the discrimination of neutrophils and eosinophils. The non-stimulated expression as well as the upregulated expression of receptors by the chemotactic peptide N-formylmethionyl-leucyl-phenyl-alanine (fMLP) were studied. The results showed that without prior stimulation only the expression of CD35 on neutrophils was significantly elevated in children with asthma (P<0.05). After up-regulation with fMLP, the CD11b expression on neutrophils (P<0.005, fMLP: 0.002 microM) and eosinophils (P<0.05, fMLP: 0.02 microM) was significantly higher in asthmatic children than in the controls. These results indicate that the inducible expression of CD11b on neutrophils and eosinophils from allergic asthmatic children is primed in vivo.

Asthma↗
PubMed1993

Endoscopic balloon dilatation of acquired airway stenosis in newborn infants: a promising treatment.

Acquired stenosis of the trachea or bronchus in newborn infants is a possible complication of perinatal intubation and mechanical ventilation. Although the exact pathophysiology is unknown, stenosis formation seems to be initiated by pressure necrosis. Prematurity is thought to be an important risk factor for acquired airway stenosis. Management of stenotic lesions may be conservative, surgical, or endoscopic. Four patients were treated with endoscopic balloon dilatation with satisfactory results. Endoscopic balloon dilatation is the method of choice in most newborn infants with acquired bronchial or tracheal stenosis.

Airway Obstruction↗