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J Janssen

Publications and source records attributed to J Janssen.

At least 19 recordsLinked to original sources
PubMed2006

Short- and long-term experience in pulmonary vein segmental ostial ablation for paroxysmal atrial fibrillation.

INTRODUCTION: Segmental ostial pulmonary vein isolation (PVI) is considered a potentially curative therapeutic approach in the treatment of paroxysmal atrial fibrillation (PAF). There is only limited data available on the long-term effect of this procedure. METHODS: Patients (Pts) underwent a regular clinical follow up visit at 3, 6 and 24 months after PVI. Clinical success was classified as complete (i.e. no arrhythmia recurrences, no antiarrhythmic drug), partial (i.e. no/only few recurrences, on drug) or as a failure (no benefit). The clinical responder rate (CRR) was determined by combining complete and partial success. RESULTS: 117 patients (96 male, 21 female), aged 51+/-11 years (range 25 to 73) underwent a total of 166 procedures (1.4/patient) in 2-4 pulmonary veins (PV). 115 patients (98%) had AF, 2 patients presented with regular PV atrial tachycardia. ,109/115 patients. exhibited PAF as the primary arrhythmia (versus persistent AF). A total of 113 patients with PVI in the years 2001 to 2003 were evaluated for their CRR after 6 (3) months. A single intervention was carried out in 63 patients (55.8%), two interventions were performed in 45 patients (39.8%) and three interventions in 5 patients (4.4%). The clinical response demonstrated a complete success of 52% (59 patients), a partial success of 26% (29 patients) and a failure rate of 22% (25 patients), leading to a CRR of 78% (88 patients). Ostial PVI in all 4 PVs exhibited a tendency towards higher curative success rates (54% versus 44% in patients with 3 PVs ablated for the 6 month follow up). Long-term clinical outcome was evaluated in 39 patients with an ablation attempt at 3 PVs only (excluding the right inferior PV in our early experience) and a mean clinical follow up of 21+/-6 months. At this point in time the success rate was 41% (complete, 16 patients) and 21% (partial, 8 patients), respectively, adding up to a CRR of 62% (24 patients). In total, 20 patients (17.1%) had either a single or 2 (3 patients, 2.6%) complications independent of the number of procedures performed with PV stenosis as the leading cause (7.7%). CONCLUSION: The CRR of patients with medical refractory PAF in our patient cohort is 78% at the 6 month follow up. PV stenosis is the main cause for procedure-related complications. Ablation of all 4 PV exhibits a tendency towards higher complete success rates despite equal CRR. Calculation of the clinical response after a mid- to long-term follow of 21+/-6 months in those patients with an ostial PVI in only 3 pulmonary veins (sparing the right inferior PV) shows a further reduction to 62%, exclusively caused by a drop in patients with a former partial success. To evaluate the long-term clinical benefit of segmental ostial PVI in comparison with other ablation techniques, more extended follow up periods are mandatory, including a larger study cohort and a detailed description of procedural parameters.

Journal Article↗
PubMed2005

Assessing adherence with toothbrushing instructions using a data logger toothbrush.

OBJECTIVES: To evaluate patient compliance with toothbrushing instructions using a data logger and a brushing diary. METHODS: Dental patients were provided with powered toothbrushes modified to carry electronic data loggers. Demonstration of the most effective way to use the toothbrush was provided with instructions to brush for 2 minutes morning and evening. Data logger brushes were supplied for two episodes of 8 weeks. Brushing time was also recorded in a diary during episode 1. RESULTS: Data from 14 brushes (2,287 recordings) were used to evaluate compliance in episode 1 Nine brushes (1,526 recordings) were used in episode 2 A total of 2,333 brushing events were reported manually in the diaries. Data logger records during episode 1 showed that only 34% of events were compliant with the instruction of a 2 minute brushing time, 20% were partially compliant (within +/-30s of 2 minutes), and 46% of events were non-compliant (>30s from 2 minutes). The respective proportions for episode 2 were 24%, 24% and 52%. Diary data reported 58% of events as compliant with 42% non-compliant. CONCLUSIONS: Manually completed brushing diaries do not provide an accurate reflection of subjects' compliance with toothbrushing instructions.

Data Collection↗
PubMed2004

[Requirements and recommendations for performing endosonographies].

For improvement of quality the working group of the Society of Gastroenterology in Nordrhein-Westfalen (Germany) was engaged with the questions, which apparative, personal and training conditions for endoscopic ultrasound are useful. The following proposals were preliminarily presented at the annual Congress of the DGVS (German Society of Digestive and Metabolic Diseases) 2001. They are thought to be subject of discussion for guidelines to be elaborated by this national society.

Biopsy, Needle↗
PubMed2003

Effect of brushing force and time on plaque removal using a powered toothbrush.

OBJECTIVES: Primary objective - To determine the effect of varying brushing forces and brushing times upon the plaque-removing efficacy of a powered toothbrush. Secondary objective - to determine the optimum combination of brushing force and time for plaque removal. MATERIAL AND METHODS: This randomised, single-blind, 16-cell, cross-over trial compared the efficacy of plaque removal of a powered toothbrush (PTB) used with four brushing forces (75, 150, 225 and 300 g) and over four brushing times (30, 60, 120 and 180 s). Twelve volunteers (18-30 years) were recruited and trained to use the Philips/Jordan Sensiflex 2000 PTB, which was modified so that specified forces and times could be recorded. Each subject was asked to abstain from all oral hygiene procedures for 24 hs prior to each brushing event, to allow plaque accumulation. Plaque was recorded using a modified Quigley & Hein index (PI) at six points per tooth before and after each episode of brushing, and the differences in the means (pre- to postbrushing) were compared. Three-way anova was undertaken to compare differences between plaque-removing efficacy for the 16 combinations of force and time. Subjects, brushing time and brushing force were used as fixed effects within the analysis. RESULTS: All 12 subjects participating completed the 16 combinations of force and time over which plaque removal was assessed. Statistically significant differences in PI reductions were found between different brushing times and forces over all tooth surfaces (p<0.001). The interaction of varying brushing force and brushing time was significant for full mouth (FM) and interproximal (IP) sites (p<0.03). No statistical significance was demonstrated for smooth surface (SS) sites, nor was it detected for the interaction of subjects with brushing force or subjects with brushing time (p>0.05). CONCLUSION: We conclude that brushing time and brushing force have significant effects upon the level of plaque removal by a PTB, and at 120 s brushing time the improvement in plaque removal with forces in excess of 150 g was negligible.

Adult↗
PubMed2003

[Endoscopic ultrasonography (EUS) of the upper gastrointestinal tract - prospective multicenter study to evaluate time and staff requirements].

BACKGROUND AND AIMS: Endoscopic ultrasonography is an important procedure in the diagnostic work-up of gastrointestinal and mediastinal masses. To evaluate the time and staff requirements for the examination, a prospective multicenter study was carried out. METHODS: 27 centers were asked to document their endoscopic ultrasonographic procedures over a 4-month period, using a standardized protocol comprising several parameters: time and staff requirements (overall and related to organs), time spent on informing the patients, preparation, performance and monitoring of the examination and subsequent care of patient as well as of endoscopic equipment. RESULTS: 484 examinations from 11 centers were suitable for evaluation, 25 % of the patients were out-patients. Median examination time was 20 minutes (range: 5 - 60 min) without significant differences concerning the device but with greater differences concerning the different organs (pancreas 23.5 minutes, esophagus 15 minutes). Median time of subsequent care was 35 minutes in out-patients, 25 minutes in hospitalized patients, with a great variety between different centers. In 70 % of examinations one doctor and one nurse were involved. For sedation midazolam was used in 90 % of cases, pethidin for analgesia in 30 % of cases. CONCLUSIONS: The obvious time and staff requirements for endoscopic ultrasonography are comparable to historical data for the performance of a colonoscopy. In out-patients the time required seems to be higher.

Diagnosis-Related Groups↗
PubMed2002

A clinical evaluation of a novel data logger to determine compliance with the use of powered toothbrushes.

OBJECTIVES: The primary objective of this study was to evaluate the viability of an electronic data logger to record the brushing episodes of patients receiving standardised oral hygiene instructions. The secondary objective was to estimate the compliance of a group of patients diagnosed with chronic periodontal disease with brushing time instructions for the daily use of a powered toothbrush over a 2-month period. MATERIAL AND METHODS: 17 modified Philips Jordan Sensiflex 2000 powered toothbrushes (PTBs) were provided to patients (32-67 years) attending for non-surgical management of chronic periodontal disease. The PTBs incorporated an electronic data logger which recorded, for each individual brushing event: the length of time the brush was used (identifying the brushing speed setting); the maximum, minimum and average current during operation; and the time spent charging in between two consecutive brushing events. The patients were given detailed instructions with the PTB and were told to use it for 2 min each morning and 2 min in the evening. The patients returned for non-surgical management over two visits prior to reinforcement of the oral hygiene instructions 1 month after PTB allocation. Subjects were asked to complete a simple brushing diary to record their use of the toothbrush on a daily basis. After 2 months of using the PTBs at home, the brushes and diaries were collected and the data downloaded from the data loggers. RESULTS: Of the 17 data loggers allocated, two recorded no information and two subjects did not return for the follow-up appointments. The data from the remaining 13 data loggers were evaluated for level of compliance. An event of brushing between 120 and 130 s was considered to be compliant, one of between 90 and 120 or 130-150 s was partially compliant and brushing for < 90 s or > 150 s was recorded as non-compliant. Percentage compliance for all the events (2087 recordings) was 34%, partial- and non-compliance were calculated as: 18%; 48% of events, respectively. CONCLUSION: This data logger has provided previously unrecorded data on the brushing times for a group of patients using a powered toothbrush at home during non-surgical management of chronic periodontal disease. The data suggested that almost half (48%) of the brushing events recorded by the data loggers were greater than 30 s above or below the instructed brushing time.

Adult↗
PubMed2001

Why do bilioduodenal plastic stents become occluded? A clinical and pathological investigation on 100 consecutive patients.

BACKGROUND AND STUDY AIMS: The main complication associated with biliary stenting is stent occlusion. This study tested the hypothesis that bilioduodenal reflux may play a crucial role in stent clogging. PATIENTS AND METHODS: Plastic stents in 100 consecutive patients with various biliary disorders were investigated macroscopically and cytologically. RESULTS: In 37 patients with elective stent extraction, the only risk factor for stent occlusion was the duration of stenting. Plant material was found as a consequence of duodenobiliary reflux in 38 of the 89 stents with any stent content. In patients who had two stents, the stent content was identical in eight of 14 cases. CONCLUSIONS: In addition to other mechanisms of biliary stent occlusion, duodenobiliary reflux appears to play an important role. A stent design capable of at least partly preventing this type of reflux might be of clinical benefit.

Adult↗
PubMed2001

Long-term results after successful extracorporeal gallstone lithotripsy: outcome of the first 120 stone-free patients.

BACKGROUND: Long-term results after successful extracorporeal shock wave lithotripsy (ESWL) of symptomatic gallbladder stones are determined by stone and complaint recurrence. The long-term outcomes of the first successfully treated patients of our Department are presented. METHODS: The first consecutive 120 patients with symptomatic gallbladder stones who became stone-free after ESWL plus oral bile acids in the years 1986 and 1987 were included in this study. They were followed up at 1-to 2-year intervals clinically and by ultrasonography until April 1998. Recurrence of stones and biliary symptoms and subsequent treatment were recorded. The effect of various factors on recurrence was analyzed. RESULTS: Median follow-up time was 6.0 years for all patients and 8.8 years for patients without recurrence (range, 0-11.2 years for both). Actuarial recurrence probability was 1.9%-16.6% per year reaching 60.2% (49.9%, 70.3%) (95% confidence interval) after 10 years. Patients with stone recurrence revealed significantly more stones before ESWL than patients without recurrence (P < 0.03). Other factors were not significantly different. The majority of stone recurrences were symptomatic requiring retreatment, mostly cholecystectomy. CONCLUSION: The probability of gallbladder stone recurrence after successful ESWL remains high during a decade of follow-up. Many patients require repeated nonsurgical treatment or cholecystectomy. Thus long-term results are unsatisfactory and ESWL should be offered only exceptionally.

Adult↗
PubMed2001

Comparison of two different temperature maintenance strategies during open abdominal surgery: upper body forced-air warming versus whole body water garment.

BACKGROUND: A new system has been developed that circulates warm water through a whole body garment worn by the patient during surgery. In this study the authors compared two different strategies for the maintenance of intraoperative normothermia. One strategy used a new water garment warming system that permitted active warming of both the upper and lower extremities and the back. The other strategy used a single (upper body) forced-air warming system. METHODS: In this prospective, randomized study, 53 adult patients were enrolled in one of two intraoperative temperature management groups during open abdominal surgery with general anesthesia. The water-garment group (n = 25) received warming with a body temperature (rectal) set point of 36.8 degrees C. The forced-air-warmer group (n = 28) received routine warming therapy using upper body forced-air warming system (set on high). The ambient temperature in the operating room was maintained constant at approximately 20 degrees C. Rectal, distal esophageal, tympanic, forearm, and fingertip temperatures were recorded perioperatively and during 2 h after surgery. Extubated patients in both groups were assessed postoperatively for shivering, use of additional warming devices, and subjective thermal comfort. RESULTS: The mean rectal and esophageal temperatures at incision, 1 h after incision, at skin closure, and immediately postoperatively were significantly higher (0.4-0.6 degrees C) in the group that received water-garment warming when compared with the group that received upper body forced-air warming. The calculated 95% confidence intervals for the above differences in core temperatures were 0.7-0.1, 0.8-0.2, 0.8-0.2, and 0.9-0.1, retrospectively. In addition, 14 and 7% of patients in the control upper body forced-air group remained hypothermic (< 35.5 degrees C) 1 and 2 h after surgery, respectively. No core temperature less than 35.5 degrees C was observed perioperatively in any of the patients from the water-garment group. A similar frequency of the thermal stress events (shivering, use of additional warming devices, subjective thermal discomfort) was observed after extubation in both groups during the 2 h after surgery. CONCLUSIONS: The investigated water warming system, by virtue of its ability to deliver heat to a greater percentage of the body, results in better maintenance of intraoperative normothermia that does forced-air warming applied only to the upper extremities, as is common practice.

Abdomen↗
PubMed2000

Toxicity of Co2+: implications for lateral line studies.

It has been reported that superficial neuromasts, a type of lateral line organ, mediate rheotaxis in fish. These studies used Co2+ at 2 mmol l(-1) for 3 h to ablate the entire lateral line system. The recommended concentration is 0.1 mmol l(-1). The present study shows that at 2 mmol l(-1) Co2+ is highly toxic to blind Mexican cave fish. Fish exposed to this concentration died in less than 17 h, and produced copious mucus. No control fish died. No cobalt treated fish died after 3 h exposure, but cobalt-treated fish swam about their aquaria faster than control fish and tended to swim at the surface. Hence, both survival and behavior were changed by the excessive concentration of Co2+.

Animals↗
PubMed2000

Derogation and distancing as terror management strategies: the moderating role of need for closure and permeability of group boundaries.

Previous research has revealed that when individuals are confronted with criticism of a personally relevant group, mortality salience can lead to either derogation of the source of criticism or distancing from the group. In this article, the authors investigated closure as a potential moderator of these reactions. In Study 1, mortality salience led to greater derogation of a critic of a relevant group among high-need-for-closure participants but led to distancing from the group among low need-for-closure participants. Study 2 showed that when a relevant group was criticized, mortality salience led to greater derogation among participants who were led to believe that the boundaries of that group were impermeable but led to greater distancing among participants who were made aware of the permeable nature of the group boundaries. These findings demonstrate that closure of group membership moderates reactions to criticism of a personally relevant group after mortality salience.

Adult↗
PubMed2000

[The liver and hereditary hemorrhagic telangiectasia].

Hereditary hemorrhagic teleangiectasia, or Rendu-Osler-Weber syndrome, is an autosomal dominant inherited disease characterized by vascular derangement in many organs. The vascular derangement includes teleangiectases, arteriovenous fistulas and aneurysms. Liver involvement in hereditary hemorrhagic teleangiectasia is a rare and sometimes severe disease which was unknown and mostly detected at autopsy until a few decades ago. Typical findings are vascular malformations and connective tissue formation with fibrosis and atypical cirrhosis. In the last years we observed five Osler patients with exclusive or prevailing involvement of the liver. An unambiguous diagnosis can be ascertained by means of a hazardous liver puncture with typical histological findings. Angiography allows a reliable identification of even minor vascular deformities. The present study was undertaken to demonstrate the courses of disease, the techniques of examination and the therapeutical options of this rare manifestation of Osler-disease. In every case one could observe hepatic malformations which were established as typical Osler findings with the assistance of histological and above all sonographical/color-Doppler-sonographical devices. These special sonographic/color-Doppler-sonographic features make it possible to give up the histological diagnostics or exhaustive investigations by means of angiography, computer-tomography or MRI.

Angiography↗
PubMed2000

[Dilatation of pancreatic duct stenoses with the ring coagulator--initial experiences].

Stenoses of the main pancreatic duct in chronic pancreatitis should be treated by interventional endoscopy. If mechanical dilatation was unsuccessful, a thermodilator has been in use in our clinic since September 1998. From September 1998 to March 1999 dilation of pancreatic duct stenoses was done by the thermodilator in six patients. An asymptomatic elevation of amylase and lipase was noticed in one patient. There were no further complications. The termodilator is a promising instrument for dilatation of difficult stenoses of the main pancreatic duct. Before general use, however, evaluation of the success and complication rates in a greater number of patients is needed.

Adult↗
PubMed1999

[The holmium-YAG laser: a suitable instrument for stone fragmentation in choledocholithiasis. The assessment of the results of its use under babyscopic control].

BACKGROUND AND OBJECTIVE: Stone fragmentation is required in ca. 5% of patients with choledocholithiasis to free the patients of stones. Several extra- and intracorporal methods of stone fragmentation (lithotripsy) have been available. We here report our experience with the recently available holmium-YAG laser, used under babyscopic monitoring. PATIENTS AND METHODS: Between September 1997 and May 1998 lithotripsy was performed by holmium-YAG laser under monitoring in 20 patients with choledocholithiasis in whom conventional methods had failed to achieve stone fragmentation. RESULTS: All stones were cleared in 19 of the 20 patients. A second session was necessary in four patients, three sessions in one. There was no serious complication and no death during a 30-day follow-up. CONCLUSION: Holmium-YAG laser lithotripsy under babyscopic monitoring has been shown to be a suitable method in patients with choledocholithiasis in whom previous treatment has failed it is complementary to current methods of stone fragmentation.

Aged↗
PubMed1999

Is the obstetric guideline of 30 minutes from decision to incision for Cesarean delivery clinically significant?

A Cesarean delivery may be critical to the health and wellbeing of a newborn. The time required to extract an infant from a hostile in utero environment is a frequent issue in medical negligence cases. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics suggest a time guideline of 30 minutes from decision for Cesarean delivery to the beginning (incision) of the procedure. This time frame is based on survey data from hospitals throughout the United States and is not based on clinical outcomes or the pathophysiology of obstetric events. This review focuses on specific Cesarean indications as noted by the specialty groups and analyzes them from an outcome point of view. The authors conclude that specific high-risk factors do indeed warrant delivery in as expedient a fashion as possible; however, compliance with the 30-minute guideline does not necessarily lead to a difference in outcome as far as the neonate is concerned.

Cesarean Section↗