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Biomedical subjects

J van Gijn

Publications and source records attributed to J van Gijn.

At least 109 records · Page 6Linked to original sources
PubMed2000

Aortic atherosclerosis at middle age predicts cerebral white matter lesions in the elderly.

BACKGROUND AND PURPOSE: MRI scans of the brains of elderly people frequently show white matter lesions. Clinically, these lesions are associated with cognitive impairment and dementia. A relation between atherosclerosis and white matter lesions was found in some small cross-sectional studies. However, atherosclerosis is a gradual process that starts early in life. We investigated the longitudinal association between aortic atherosclerosis assessed during midlife and late life and cerebral white matter lesions. METHODS: We randomly sampled subjects between 60 and 90 years old from 2 population-based follow-up studies in which subjects had their baseline examinations in 1975 to 1978 (midlife) and in 1990 to 1993 (late life). In 1995 to 1996, subjects underwent 1.5-T MRI scanning; white matter lesions were rated in the deep subcortical and periventricular regions separately. Aortic atherosclerosis was assessed on abdominal radiographs that were obtained from 276 subjects in midlife and 531 subjects in late life. RESULTS: The presence of aortic atherosclerosis during midlife was significantly associated with the presence of periventricular white matter lesions approximately 20 years later (adjusted relative risk, 2.4; 95% CI, 1.2 to 5.0); the relative risks increased linearly with the severity of aortic atherosclerosis. No association was found between midlife aortic atherosclerosis and subcortical white matter lesions (adjusted relative risk, 1.1; 95% CI, 0.5 to 2.3) or between late-life aortic atherosclerosis and white matter lesions. CONCLUSIONS: The pathogenetic process that leads to cerebral periventricular white matter lesions starts already in or before midlife. The critical period for intervention directed at prevention of white matter lesions and its cognitive consequences may be long before these lesions become clinically detectable.

Age Factors↗
PubMed1999

[Importance of supplementary testing for diagnostic proficiency at the bedside].

Two patients are described who were originally published in Reports of medical cases (1827; 1831) by Richard Bright. The first patient suffered from haematuria and oedema (dropsy) and died after acute epiglottitis. At autopsy the kidneys were swollen and haemorrhagic (acute glomerulonephritis in present terms). The second patient died after two episodes of acute headache and decreased consciousness. At autopsy an aneurysmatic dilatation of a brain artery was found. Today the diagnosis of acute glomerulonephritis or subarachnoid haemorrhage would have been made from the history and physical examination, and newly developed laboratory and histological techniques would have been helpful in securing it. But even nowadays, clinical skills are still continually expanding by feedback from new diagnostic techniques.

Acute Disease↗
PubMed1999

[From the library of the Dutch Journal of Medicine: Richard Bright (1789-1858) and his 'Reports of Medical cases'].

At the beginning of the 19th century, medicine underwent an important metamorphosis. The emphasis shifted from function to structure, and from organism to organ. This went hand in hand with the development of the physical examination. The founders of the new movement were Italian and French. In Great Britain, Richard Bright (1789-1858) was an important pioneer. In his books Reports of medical cases, published in 1827 and 1831, with many colour plates, Bright correlated clinical features with morphological changes found at autopsy. He became most famous for showing the relationship of dropsy, coagulable urine and kidney changes. Acute glomerulonephritis is named after him. With Addison and Hodgkin he contributed to the fame of Guy's Hospital in London.

Eponyms↗
PubMed1999

[A century of stroke in the Dutch Journal of Medicine (1857-1956)].

In the middle of the 19th century physicians performing autopsy could recognise cerebral softening through arterial occlusion, and distinguish it from intracerebral haemorrhage (apoplexy). During life diagnostic possibilities were limited, until the introduction of arteriography in 1927. A low blood pressure and embolism from the heart were considered possible causes of brain softening. After the turn of the century, when blood pressure could be measured, cerebral haemorrhage was generally attributed to arterial hypertension. The anatomical substrate of brain haemorrhage was controversial: bursting of a microaneurysm or a sclerotic artery, and primary infarction followed by increased permeability of vessel walls were all proposed as intermediate events. The subject of subarachnoid haemorrhage was first mentioned in the 1930s. Migraine and toxic factors were initially implicated as causes, later especially aneurysms. In the 19th century treatment of stroke would often involve blood-letting and application of dressings. Lumbar puncture was used in the 1920s and 30s for subarachnoid or intracerebral haemorrhages. In 1950 the first report about surgical occlusion of cerebral aneurysms appeared in the Journal.

Cerebral Hemorrhage↗
PubMed1999

[Creative mathematics with clopidogrel; exaggeration of the preventive effect by manufacturer].

A number of Dutch medical journals recently carried an advertisement stating that clopidogrel treatment reduced the number of ischaemic complications with 26%, compared with aspirin treatment. This is a miscalculation: the actual reduction is 0.51% in absolute rates, and 8.7% in relative terms. The error by Sanofi-Synthelabo arose by comparison of the event rates for clopidogrel (5.32%) as well as for aspirin (5.83%) with that in an imaginary placebo group (7.77%), yielding a reduction of ischaemic complications of 2.45% and 1.94% respectively; erroneous comparison of these two numbers leads to a difference of 26%.

Advertising↗
PubMed1999

Diagnostic value of myotactic reflexes in axonal and demyelinating polyneuropathy.

In 11 patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and 11 patients with chronic idiopathic axonal polyneuropathy (CIAP), absent myotatic reflexes were significantly associated more often with CIDP than with CIAP, an absent biceps-reflex having the highest sensitivity and specificity for the diagnosis of CIDP. In CIDP, the latencies of electromyographically recorded myotatic reflexes often indicated demyelination, notwithstanding normal clinically assessed myotatic reflexes. Myotatic reflexes may therefore be useful for the distinction between axonal and demyelinating polyneuropathy.

Aged↗
PubMed1999

[Roaming through methodology. XV. Smoking grandfathers and other selection biases].

That some cigarette smokers live until 90 years of age does not allow conclusions about the life expectancy of smokers in general as, after all, the dead are invisible. In the same way, a case-control study of factor F (e.g. smoking) as a determinant of disease D (e.g. Alzheimer's disease) may be biased by excess mortality in subjects with the combination of disease D and factor F. The result is an underestimation of the combination F-D in survivors (survival bias). A different form of bias may occur in hospital-based observational studies, e.g. of patients with disease Y (brain infarction), with or without previous treatment with drug A (aspirin). If previous treatment is associated with relatively mild deficits, while only patients with severe deficits are admitted, the difference in stroke severity cannot be observed in hospital (referral bias). In comparison with a population-based follow-up study important groups of patients may, in either example, have been lost in the study.

Case-Control Studies↗
PubMed1999

[Acute severe headache: a subarachnoidal hemorrhage?].

Five patients, three women aged 87, 50, and 31 years, and two men aged 31 and 32 years, presented with severe headache of sudden onset. A sudden onset of unusually severe headache is suggestive of an intracranial haemorrhage or other serious disease, even in the absence of focal neurologic deficits. The diagnoses were subdural haematoma, cerebral venous sinus thrombosis, idiopathic thunderclap headache, subarachnoid haemorrhage, and viral meningitis, respectively. There are no characteristics from history or examination that accurately discriminate among all these causes; idiopathic thunderclap headache and subarachnoid haemorrhage are commonest. Consultation of a neurologist and further ancillary investigations are necessary for proper diagnosis and treatment.

Adult↗
PubMed1999

[Physical diagnosis--plantar reflex].

On stimulation of the plantar surface an extensor response of the toes (especially the big toe; Babinski sign) indicates a disorder of the corticospinal system: disinhibition of reflex activity causes the big toe to be recruited into the synergistic flexion reflex of the leg (toe extensors are flexors in a physiological sense). Proper assessment of the plantar reflex therefore involves not only rating toe movements, but also observing simultaneous contraction of flexor muscles in the thigh. Disregard of the association with the flexion synergy has given rise to some misunderstandings.

Adolescent↗
PubMed1999

A follow-up study of blood pressure and cerebral white matter lesions.

White matter lesions are often observed on cerebral magnetic resonance imaging scans of elderly people and may play a role in the pathogenesis of dementia. Cross-sectional studies have shown an association between elevated blood pressure and white matter lesions. We prospectively studied the relation between blood pressure and white matter lesions in 1,077 subjects aged 60 to 90 years who were randomly sampled from two prospective population-based studies. One study had blood pressure measurements 20 years before, the other 5 years before. Overall response for the magnetic resonance imaging study was 63%, and declined from 73% among 60- to 70-year-olds to 48% for 80- to 90-year-olds. Diastolic and systolic blood pressure levels assessed 20 years before were significantly associated with subcortical and periventricular white matter lesions. The association between 20-year change in diastolic blood pressure and subcortical white matter lesions was J-shaped (relative risk, 2.2; 95% confidence interval, 1.0-5.2; and relative risk, 3.2; 95% confidence interval, 1.4-7.4, for decrease or increase of more than 10 mm Hg, respectively). The association between concurrent diastolic blood pressure level and white matter lesions was linear in subjects without, and J-shaped in subjects with, a history of myocardial infarction. Our results indicate that the J-shape relationship of diastolic blood pressure is not restricted to cardiovascular disease, but is also manifest in cerebrovascular disease.

Age Factors↗
PubMed1999

Follow-up of idiopathic thunderclap headache in general practice.

Follow-up studies of idiopathic thunderclap headache (ITH) have found no subsequent subarachnoid hemorrhage (SAH) or other serious neurological disease, but the effect on life-style has not been studied. To assess the long-term outcome of patients with ITH in general practice we prospectively followed 93 patients with an episode of ITH during 1988-1993, of whom 77 were referred to hospital. ITH was defined as a sudden, unusually severe headache that started within 1 min, lasted at least 1 h, and for which no underlying cause was found. These patients were treated in 252 general practices. Outcome measures were subsequent SAH, subsequent headaches, absence from work, and diminished daily functioning. Patients were followed up by their general practitioner for a median of 5 years (range 1-10). Three patients died, all from non-neurological diseases. No subsequent SAH was diagnosed in any of the 93 patients. Recurrent attacks of ITH occurred in 8 patients, and 13 developed new tension headache or migraine. Absence from work because of headache was recorded in 11 patients, and in the overall group 6 patients were dependent on welfare. In only one-half of patients (n=52) did the general practitioner judge the level of daily functioning to be similar to that before the index episode of ITH. Thus, although no episodes of SAH occurred after ITH during long-term follow-up, one-half of patients with ITH had a lower level of daily functioning, and one-eighth had reduced working capacity, specifically because of headache.

Absenteeism↗
PubMed1999

How do general practitioners diagnose and manage patients with transient monocular loss of vision of sudden onset?

Symptoms of transient loss of vision in one eye differ widely. They may have different causes and therefore carry a different prognosis. We studied the influence of differences between characteristics of transient monocular blindness on the diagnosis and management by general practitioners (GPs). A postal questionnaire, was sent to 1600 GPs in The Netherlands along with four case vignettes describing a case history of a 56-year-old man with transient monocular disturbances of vision of sudden onset. We introduced random permutations in the following four elements of the history: partial or complete visual field involved, blurring or blacking out of vision, attacks lasting minutes or hours, and patients having covered either eye during the attack or not. Respondents were asked about the probable diagnosis and the preferred management. For each of the 16 permutations about 50 responses were obtained (overall response rate 54%). Ischemic transient monocular blindness (ITMB) was chosen as the most likely diagnosis in 49%. In 12% primary ocular disease was suspected. Involvement of the complete visual field, blacking out of vision, and short attacks were identified as independent predictors of a diagnosis of ITMB. A diagnosis of ITMB would have resulted in referral to a specialist in 72% of patients. Antithrombotic treatment would have been initiated in only 36% of ITMB patients. GPs consider brief attacks with complete blacking out of vision most typical for retinal ischemia. They refer only three-quarters of patients with probable ITMB to a specialist and start antithrombotic medication in only one-third of these patients. Therefore further education with regard to transient monocular blindness is needed.

Amaurosis Fugax↗