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Biomedical subjects

K Bakker

Publications and source records attributed to K Bakker.

At least 19 recordsLinked to original sources
PubMed2006

High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study.

AIMS/HYPOTHESIS: Large clinical studies describing the typical clinical presentation of diabetic foot ulcers are limited and most studies were performed in single centres with the possibility of selection of specific subgroups. The aim of this study was to investigate the characteristics of diabetic patients with a foot ulcer in 14 European hospitals in ten countries. METHODS: The study population included 1,229 consecutive patients presenting with a new foot ulcer between 1 September 2003 and 1 October 2004. Standardised data on patient characteristics, as well as foot and ulcer characteristics, were obtained. Foot disease was categorised into four stages according to the presence or absence of peripheral arterial disease (PAD) and infection: A: PAD -, infection -; B: PAD -, infection +; C: PAD +, infection -; D: PAD +, infection +. RESULTS: PAD was diagnosed in 49% of the subjects, infection in 58%. The majority of ulcers (52%) were located on the non-plantar surface of the foot. With regard to severity, 24% had stage A, 27% had stage B, 18% had stage C and 31% had stage D foot disease. Patients in the latter group had a distinct profile: they were older, had more non-plantar ulcers, greater tissue loss and more serious comorbidity. CONCLUSIONS/INTERPRETATION: According to our results in this European cohort, the severity of diabetic foot ulcers at presentation is greater than previously reported, as one-third had both PAD and infection. Non-plantar foot ulcers were more common than plantar ulcers, especially in patients with severe disease, and serious comorbidity increased significantly with increasing severity of foot disease. Further research is needed to obtain insight into the clinical outcome of these patients.

Aged↗
PubMed2002

Bone tissue-engineered implants using human bone marrow stromal cells: effect of culture conditions and donor age.

At present, it is well known that populations of human bone marrow stromal cells (HBMSCs) can differentiate into osteoblasts and produce bone. However, the amount of cells with osteogenic potential that is ultimately obtained will still be dependent on both patient physiological status and culture system. In addition, to use a cell therapy approach in orthopedics, large cell numbers will be required and, as a result, knowledge of the factors affecting the growth kinetics of these cells is needed. In the present study we investigated the effect of dexamethasone stimulation on the in vivo osteogenic potential of HBMSCs. After a proliferation step, the cells were seeded and cultured on porous calcium phosphate scaffolds for 1 week, and then subcutaneously implanted in nude mice for 6 weeks, in order to evaluate their in vivo bone-forming ability. Furthermore, the effect of donor age on the proliferation rate of the cultures and their ability to induce in vivo bone formation was studied. In 67% of the assayed patients (8 of 12), the presence of dexamethasone in culture was not required to obtain in vivo bone tissue formation. However, in cultures without bone-forming ability or with a low degree of osteogenesis, dexamethasone increased the bone-forming capacity of the cells. During cellular proliferation, a significant age-related decrease was observed in the growth rate of cells from donors older than 50 years as compared with younger donors. With regard to the effect of donor age on in vivo bone formation, HBMSCs from several donors in all age groups proved to possess in vivo osteogenic potential, indicating that the use of cell therapy in the repair of bone defects can be applicable irrespective of patient age. However, the increase in donor age significantly decreased the frequency of cases in which bone formation was observed.

Age Factors↗
PubMed2001

Continuous-flow analysis of dissolved inorganic carbon content in seawater.

A rapid, continuous-flow determination of total inorganic carbon (TIC) in seawater samples is presented. The method runs on an autoanalyzer Traacs 800 spectrophotometric system and is calibrated versus certified reference materials readily available. A typical analysis speed of 45 samples/h can be reached with an accuracy of 2-3 microM and a precision of approximately 2.5 microM. The analysis requires only a small amount of sample and is thus ideally suited for pore water samples and samples taken from cultures where sample volume is at a premium. The speed of the analysis makes mapping of oceanic surface water characteristics possible. Potential interference of sulfide in anoxic (e.g., pore water) samples can be masked by the addition of a hydrogen peroxide step. Although the latter is a strong oxidative reagent, no significant effect on TIC concentration due to oxidation of (labile) organic matter could be found.

Carbon↗
PubMed2000

[New developments in the treatment of diabetic foot ulcers].

Diabetic foot ulcers are frequent: 12,000 Dutch diabetes patients have such an ulcer. The ulcers have a multifactorial aetiology: polyneuropathy, biomechanical stress, infection, deficient footwear and to a less extent ischaemia are the major factors. The principles of ulcer treatment are relief of pressure, restoration of skin perfusion, treatment of infection, intensive wound care, metabolic control, treatment of comorbidity, and instruction of the patient. Wound healing is slow. The impaired wound healing is probably caused by deficiencies in local growth factors, changes in the extracellular matrix, diminished fibroblast function, decreased antimicrobial activity of leukocytes and disturbances in the macro- and microcirculation. In recent years several new treatment strategies have been developed to stimulate wound healing in diabetic foot ulcers. These (partly experimental) treatments include: topical growth factors, extracellular matrix products, bioengineered human skin, granulocyte colony stimulating factor and hyperbaric oxygen therapy. In particular recombinant human platelet derived growth factor (becaplermin) has proved to be clinically effective in chronic neuropathic foot ulcer and has been approved in the Netherlands.

Becaplermin↗
PubMed2000

[Diabetic peripheral neuropathy: international guidelines for prevention, diagnosis, and treatment].

Recently, international guidelines for the diagnosis and management of diabetic polyneuropathy were issued. The aim of this initiative was to develop simple and practical guidelines for general practitioners and hospital physicians in day-to-day practice. Regular assessment of peripheral nerve function can be performed in diabetic patients using simple diagnostic tools. In such a way, patients will become more aware of the risks associated with diabetic neuropathy. Early detection of neuropathy and other risk factors for the development of foot ulcers may lead to avoidance of amputations. The guidelines emphasize foot care education of diabetic patients with or without neuropathy and early referral of patients with ulcerations to specialised outpatient foot clinic.

Amputation, Surgical↗
PubMed2000

General practitioners on dementia: tasks, practices and obstacles.

The objective of the study was to identify the GPs' perception of their tasks, their practice and obstacles concerning the diagnosis and management of dementia. Twenty-eight GPs participated in focus-group interviews and completed a questionnaire. The GPs perceived their tasks to diagnose, inform and manage dementia patients and their relatives preferably from an early stage on and in such a way that patients are able to stay at home as long as possible. Nevertheless, the GPs diagnose usually in a more progressed stage. As main reasons for this delay the GPs mentioned diagnostic uncertainty during the early stages, embarrassment to conduct a cognitive examination and communicate the diagnosis, non-consulting patients and a lack of time. A discrepancy was found between the GPs' views of their tasks and their clinical practice regarding dementia. Important obstacles were reported that can explain the diagnostic delay and may prevent appropriate education of family caregivers in dealing with demented patients such as embarrassment to examine and communicate this condition.

Attitude of Health Personnel↗
PubMed1999

Melioidosis.

Melioidosis is an infection with the gram-negative bacillus Burkholdria pseudomallei, previous known as Pseudomonas pseudomallei. We present a case report of a man with Non-Hodgkin's Lymphoma, who after visiting Indonesia presented himself with a urosepsis, with positive cultures to B. pseudomallei. Melioidosis is endemic in areas of southeast Asia and the northern part of Australia. Infection with the B. pseudomallei has a high mortality rate. Diagnosis can be made on the basis of cultures, the bacteria grow on standard media. Treatment should be based up on sensitivity studies. The optimum duration of therapy and choice of antibiotics remain to be determined. Due to the increase in travel, the infection will be seen more frequently in other parts of the world.

Anti-Bacterial Agents↗
PubMed1999

Technical solutions for quantitative and qualitative assessments of speech fluency.

Current and emerging technical solutions for the differential diagnostic evaluation and assessment of speech fluency are reviewed and discussed. These systems were selected with just one intentional bias--the need for clinicians to carry out valid, reliable, and accurate measurements of speech fluency, its disruptions, and associated clinical features. Some seasoned technical solutions for the assessment and evaluation of stuttering have been known for many years, but have received little attention. Recently, a number of new options have appeared, and others are in the final stage of development. Empirical data about the performance or functionality of all of these technologies are lacking. As a result, clinicians who purchase them do not have access to adequate performance-related data. This article should help clinicians make reasonable judgments about the effectiveness of emerging technologies specific to assessment of speech fluency.

Adult↗
PubMed1999

Clinical technologies for the reduction of stuttering and enhancement of speech fluency.

Among the clinical technologies for the treatment of fluency disorders presented in this article are systems for assisting and automating feedback on stuttering severity, establishing speech changes that enhance fluency, and modifying speech-related sensory feedback for fluency enhancement. Some additional technologies, which have been implemented only in research but are expected to find their way to clinicians in the near future, are also discussed. The effectiveness of microcomputer applications for the treatment of stuttering has received little research; however, some answers about their effectiveness may be inferred from descriptions of their operational features and published specifications.

Adult↗
PubMed1999

Podiatric care for diabetic patients with foot problems: an observational study.

The aims of this study were to describe podiatric care for diabetic patients with foot problems and to explore the changes in knowledge, self-care behaviour and physical functioning after podiatric care. The treatment characteristics of 26 diabetic patients referred to podiatry were assessed. Prior to the first podiatric visit (T1) and 20 weeks later (T2) these patients filled in a structured questionnaire and performed a six-minute walking test. In half the number of patients preventive goals were set and strived for by general education about the diabetic foot and advice on footwear and self-care behaviour. With regard to treatment, reduction of pain was the most frequently selected goal. To achieve this reduction, a variety of interventions was applied. After podiatric care, patients reported having less severe foot pain and some improvements in functional ability and self-care behaviour were found. This study offers clues to start controlled clinical trials on the effectiveness of podiatry for diabetic patients. Trials should not only be directed to (the role of podiatry in) ulcer healing; it may be even more significant to study its effectiveness for the purpose of prevention and treatment of early-stage diabetic foot symptoms.

Activities of Daily Living↗
PubMed1999

The Dutch consensus on the diabetic foot.

In 1996 the Dutch Diabetes Federation installed a consensus committee to formulate practical guidelines for daily practice to prevent, diagnose and treat foot-related complications in patients with diabetes mellitus. A list of definitions was formulated. A new ulcer classification was introduced. Pathophysiology, diagnostic and therapeutic strategies were discussed with special attention for patients with a high risk foot and for prevention instruction. After several rounds of implementation the definite document was unanimously accepted in the fall of 1998.

Diabetic Foot↗
PubMed1998

Clinical and functional correlates of foot pain in diabetic patients.

PURPOSE: Patients with diabetes mellitus frequently suffer from foot pain. This pain seems to be a neglected area in studies on the diabetic foot. The purpose of this study was to identify clinical variables associated with foot pain in diabetic patients. In addition, the relationships between foot pain and several functional impairments and disabilities were explored. METHOD: The research group consisted of 29 diabetic patients with any symptoms possibly associated with a diabetic foot, who were referred to podiatry. The relationships between several clinical measures and foot pain were analysed by means of Mann-Whitney U-tests. In addition, Spearman rank correlations coefficients were computed to assess the relationships between foot pain and measures of functional health. RESULTS: Diabetic patients suffering from sensory neuropathy experience more severe foot pain. Furthermore, patients with more severe foot pain experience more fatigue, more disabilities in walking and a lower level of affective well-being. CONCLUSION: Based on these findings this paper concludes that foot pain in diabetic patients is an important impairment which deserves further scientific attention.

Adolescent↗
PubMed1997

The use of etidronate and calcium versus calcium alone in the treatment of postmenopausal osteopenia: results of three years of treatment.

The purpose of this open, prospective, controlled, randomized trial was to study the effect of intermittent, cyclic etidronate on the bone mass of osteoporotic postmenopausal women with or without fractures. Eligible subjects were asymptomatic women less than 75 years old who had been amenorrhoeic for at least 1 year. Those with secondary osteoporosis were excluded. Subjects also had to be ambulant with a bone mineral density (BMD) of the lumbar spine > 1 SD below that of age matched controls (Z-score < -1 SD). Eighty patients were enrolled, of whom 65 were recruited through a screening programme conducted in the practices of two general practitioners. The remaining patients were from other referrals. The subjects were randomized to two groups of 40 women. Treatment regimens were as follows. The etidronate group was treated with etidronate 400 mg once daily for 14 days followed by 76 days of 500 mg of elementary calcium once daily; this cycle was repeated every 3 months. The calcium group took 500 mg of elementary calcium once daily. The groups were not different in age, height, weight, time since menopause. BMD at baseline and prevalent vertebral fractures. In 50 patients (28 in the etidronate group and 22 in the calcium group) no vertebral fractures were present (67%). Sixty-four patients (35 in the etidronate group and 29 in the calcium group) completed the 3 years of the study. In the etidronate group the mean BMD of the lumbar spine, femoral neck, trochanter and Ward's triangle increased by 5.7%, 1.4%, 7.1% and 10.9% from baseline values respectively (p < 0.05 at all sites except for the femoral neck). In the calcium group no significant changes from baseline were found at any time point at any site after 3 years, except for the femoral neck, where BMD at 156 weeks decreased significantly by 3% (p < 0.003). In 3 patients, all in the calcium group, six new fractures were found. There were no serious adverse effects. We conclude that intermittent, cyclic treatment with etidronate causes a significant increase in the BMD of the lumbar spine and the proximal femur in osteopenic postmenopausal women, and that treatment is safe and has no serious adverse effects.

Absorptiometry, Photon↗
PubMed1996

Treatment of diabetic polyneuropathy with the neurotrophic peptide ORG 2766.

The efficacy of the neurotrophic peptide ORG 2766 in diabetic patients with polyneuropathy was evaluated in a double-blind, placebo-controlled, multicentre trial. One hundred and twenty four patients were randomised in five groups to receive 0.1, 0.4, 2 or 5 mg ORG 2766 or placebo, once daily, administered subcutaneously 52 weeks. Thermal discrimination thresholds (TDT) and vibration perception thresholds (VPT), motor and sensory nerve conduction velocity, Hoffmann reflex, heart rate variation during deep breathing and heart rate response after standing up, neurological examination score and neuropathic symptom score were determined at baseline and after 17, 34 and 52 weeks of treatment. Of the nerve function indices studied, at week 52 the TDTwarmth of the hand in the ORG 2766 0.1, 0.4 and 5 mg groups and the TDTcold of the foot in the ORG 2766 0.1 and 0.4 mg groups significantly improved compared with placebo. Further significant improvement as compared with placebo was observed in the paraesthesia score at week 34 and week 52 in the ORG 2766 2 mg group. Only at week 34 had both the heartbeat variation during deep breathing and the VPT of the foot in the ORG 2766 0.1 mg group improved significantly, compared with placebo. No further statistically significant differences were observed at time for the other measures. No adverse reactions were observed. The only recorded drug-induced side effect was pain at the injection site. Taking all measures of efficacy into account, the statistically significant results observed did not show consistency within each measure. Therefore, it is concluded that ORG 2766, in contrast to earlier reports, is not effective in treating diabetic polyneuropathy.

Adrenocorticotropic Hormone↗
PubMed1994

[A specialized outpatient foot clinic for diabetic patients decreases the number of amputations and is cost saving].

OBJECTIVE: Evaluation of the effectiveness of a foot clinic for diabetes patients. DESIGN: Retrospective study and cost-effect analysis. SETTING: Spaarne Hospital, Heemstede. METHOD: The effectiveness of 5 years's activity (1987-1991) of a foot clinic was measured by comparing its patient population, the presenting ulcers and amputations, the average stay in hospital and the cost reduction with 1983-1986. RESULTS: From 1987 to 1991 4323 diabetic check-ups were done in the clinic, of which 810 were first referrals. Of these first referrals 112 presented with a leg ulcer. Compared with the period before the establishment of the clinic in 1987, hospital admission for diabetic foot problems decreased from 48 to 29 days and 30 admissions could be prevented. The number of amputations decreased by 43%. The reduction in costs was calculated to be about Dfl. 325,000.--annually. CONCLUSION: A specialised foot clinic reduces morbidity and cost in diabetes foot care. Central figures in this clinic are a chiropodist and a nurse, supported by a surgeon and specialists in internal diseases, rehabilitation and footwear.

Aged↗
PubMed1994

Increasing incidence of type I diabetes in The Netherlands. The second nationwide study among children under 20 years of age.

OBJECTIVE: A nationwide retrospective study was conducted to assess the incidence of type I diabetes in The Netherlands among children < 20 years of age in 1988-1990. The first study with a similar design covered 1978-1980. RESEARCH DESIGN AND METHODS: The capture-recapture census method was chosen for analysis of the data. A questionnaire was sent to all Dutch pediatricians and internists, and for the ascertainment, a similar questionnaire was sent out separately to members of the Dutch Diabetes Association, which is the national patient association. RESULTS: The average achieved ascertainment rate was 81%. The ascertainment-adjusted annual incidence was 13.2/100,000 for 0- to 19-year-old children, indicating an increase of 23% compared with the 1978-1980 survey; for 0- to 14-year-olds, the increase amounted to 17%. CONCLUSIONS: This study suggests a sustained increase of type I diabetes in The Netherlands because the cumulative incidence studied previously in the 1960-1970 birth cohorts of male army conscripts 18 years of age was also found to rise. In contrast to Northern European countries, an increase in incidence for the age category 0-4 years could not be found.

Adolescent↗