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P J Brombacher

Publications and source records attributed to P J Brombacher.

At least 19 recordsLinked to original sources
PubMed1996

Laboratory work flow analysis and introduction of a multi-functional analyser.

Laboratory work flow analysis was performed in order to define guidelines for improved laboratory organisation and efficiency. All activities were monitored from the moment a laboratory test was requested until the result was reported and received. Detailed information was collected on numbers of samples and tests, work-stations and sample splitting, number of staff and laboratory costs and management. From the data thus obtained requirements for optimal reorganisation could be developed. Reduction of work-stations appeared to be of primary importance. This could be achieved by replacement of seven different work stations by instruments for multi-functional analysis (Cobas Integra) in the department of routine clinical chemistry. Effects of reorganisation were evaluated by repeated work flow analysis. The multifunctionality of the analysers (photometry, turbidimetry, ion selective electrodes and fluorescence polarisation) provides opportunities for efficient work structuring, avoiding the need for sample splitting, distribution of sub-samples and performing analyses at different work stations. Manual and clerical errors could thus be reduced. Laboratory service to clinicians was improved by reduction of turnaround times to such an extent that all test results are reported within 60 minutes (stat service) even during peak hours. Laboratory costs were reduced by decreasing the number of laboratory staff and work-stations. Both clinicians and patients expressed great satisfaction with the effects of this reorganisation, for which work flow analysis appeared to be an indispensable instrument.

Blood Chemical Analysis↗
PubMed1994

Clinical biochemistry training in The Netherlands.

A unique situation for clinical biochemistry exists in the Netherlands, since it is nearly fully practised by science-oriented professionals. They are enlisted in the Register of Recognized Clinical Biochemists supervised by the Netherlands Society of Clinical Chemistry. Training as a clinical biochemist consists of a 4-year period in a hospital laboratory; it is not a specific university education. Strictly specified requirements exist for trainee, tutor, laboratory and hospital to maintain the quality of our profession. The candidate has to become acquainted with the following aspects: general clinical biochemistry (including haematology), fundamental research, clinical orientation and management. Passing the yearly examination and publishing two articles in international journals are an obligation. Continuing education is not yet compulsory, but is well formalized within our society. European unification asks for one regulation of clinical biochemistry on a European level, both for professionals with a medical and a science-oriented background.

Biochemistry↗
PubMed1994

Value of maternal fructosamine in the screening of an unselected population for hyperglycemia-related complications in the newborn.

The relationship between the maternal serum fructosamine concentration and pregnancy outcome was studied in 765 consecutive subjects of an obstetric community hospital population. The neonatal outcome of patients with a fructosamine concentration in pregnancy below and above 2.30 mmol/L were compared. Patients with a fructosamine concentration above 2.30 mmol/L did not show an increased incidence of neonatal hypoglycemia, hyperbilirubinemia, or respiratory distress syndrome. On the other hand, they did give birth to infants with a higher birthweight ratio, a variable defined as newborn weight corrected for sex, gestational age, and parity. However, the predictive value with respect to birthweight ratio was modest: Fructosamine accounted for only 1.4% of the variation in birthweight ratio, much less than other well-known contributors to this variation, such as smoking (10%) and prepregnancy maternal (6.5%) or paternal weight (2.8%). The screening value of fructosamine to identify patients who would give birth to a macrosomic infant was limited irrespective the gestational age at measurement. It is concluded that fructosamine determined during pregnancy in an unselected obstetric population is an unsuitable screening method to trace patients with an increased risk to deliver of an infant with neonatal complications of maternal hyperglycemia.

Adult↗
PubMed1993

Enhanced production of calcitriol, and hypercalcaemia in a patient with sarcoidosis provoked by daily intake of calciol.

A case of sarcoidosis is described which presented with hypercalcaemia and renal insufficiency. Initially, a calciol intoxication was diagnosed, because a high daily intake was suspected. However, vitamin D3 metabolites in the blood revealed normal concentrations of calcidiol, but extremely high concentrations of calcitriol. These features rejected the first diagnosis and pointed to high endogenous calcitriol production, which may take place in granulomatous diseases. This is caused by an increased 1-alpha-hydroxylation reaction in activated macrophages. Eventually, muscle biopsy revealed non-caseating granulomas, confirming the diagnosis of sarcoidosis.

Aged↗
PubMed1991

The effect of maximal doses of formoterol and salbutamol from a metered dose inhaler on pulse rates, ECG, and serum potassium concentrations.

In a randomized, double-blind, crossover cumulative study, the individual maximal bronchodilator dosages for formoterol (F) and salbutamol (S) were assessed for their respective influence on ECG, pulse rate, and serum potassium levels in 13 patients with stable and reversible asthma. The following dosages were administered with an interval of 1 h: 12-24-48-(48)-(48) micrograms for F and 100-200-400-400-(400)-(400) micrograms for S. The study day was discontinued if pulse rate was above 140 beats min-1, a flattening of T wave on the ECG was recorded, or a maximal bronchodilation in FEV1 was observed (above 110 percent of the predicted value or an increase in FEV1 in the last two measurements below 5 percent). The maximal individual dose of F administered was 84 micrograms in six patients, 132 micrograms in three patients, 180 micrograms in three patients, and 228 micrograms in one patient. For S, the maximal individual dose was 400 micrograms in three patients, 2,200 micrograms in eight patients, 3,000 micrograms in one patient, and 3,800 micrograms in one patient. The mean maximal increase in FEV1 was 36.0 percent after F and 35.1 percent after S. Pulse rate increased from 73 to S3 beats.min-1 after F and from 75 to 84 beats.min-1 after S (both statistically significant). No pulse rate above 140 beats.min-1 was observed. In the high-therapeutic range (up to 36 micrograms of F and 6,090 micrograms of S), no changes in potassium level were observed. In still higher dosages, mean potassium level decreased from 4.16 to 3.78 mmol.L-1 after F and from 4.02 to 3.88 mmol.L-1 after S (not clinically relevant). The lowest individual potassium level recorded was 3.1 mmol.L-1. No clinically important changes in ECG were observed. In conclusion, very high doses of F and S administered from a metered dose inhaler proved to be safe for patients.

Albuterol↗
PubMed1991

Diamine oxidase activity in amniotic fluid for diagnosis of ruptured membranes.

Diamine oxidase in vaginal effluent is used as a parameter for ascertaining the state of fetal membranes. A new method using tritiated putrescine as a substrate is described for the determination of diamine oxidase in amniotic fluid and vaginal effluents. A number of tests are used for the diagnosis of premature rupture of fetal membranes. The described procedure for diamine oxidase activity determination can be used in general hospitals and has advantages over other parameters such as pH, glucose or fructose concentration, and the amniotic fluid crystallization test.

Amine Oxidase (Copper-Containing)↗
PubMed1991

The value of laboratory tests in patients suspected of acute appendicitis.

The clinical usefulness of laboratory tests was examined in 258 patients admitted to the emergency room with the general practitioner's tentative diagnosis, acute appendicitis. Acute appendectomy was performed on 91 patients. Histological examination of the appendix confirmed the diagnosis in 69 cases (acute appendicitis 20, phlegmonous appendicitis 36, perforation 13). Seven patients with appendicular infiltrate were not subjected to operation but the diagnosis was clear from clinical examination. On close examination/operation by the surgical team, 96 admitted patients were excluded from the primary diagnosis, acute appendicitis, and served as a control group. Receiver Operation Characteristic curves (ROC-curves) showed that the sensitivity and specificity and hence diagnostic efficiency for total white blood cell count, number of segmented leukocytes and C-reactive protein concentration for the detection of acute appendicitis were higher than for erythrocyte sedimentation rate, alpha 1-antiproteinase concentration and body temperature. We observed that when all three parameters, C-reactive protein, white blood cell count and segmented leukocytes, are within the normal range the diagnosis, acute appendicitis is highly unlikely. The diagnostic value of the different laboratory parameters appears, moreover, to be highly dependent on the degree of inflammation/perforation and the development of appendicular infiltration. However, diagnostic efficiency can be improved, and unnecessary surgery prevented, by performance of an appropriately selected combination of laboratory tests combined with evaluation of clinical symptoms.

Acute Disease↗
PubMed1991

Quantitative determination of non-haem iron and ferritin iron in bone marrow using flameless atomic absorption spectrophotometry. A comparative study on the cytological and chemical determination of the bone marrow iron content.

A method for non-haem iron analysis in bone marrow aspirates using graphite furnace atomic absorption spectrophotometry has been developed. Bone marrow aspirates were obtained from patients with various disorders. A good correlation is observed between chemical and cytological assessment of total non-haem iron in bone marrow. An intra-assay coefficient of variation of 9.0% was observed. The ferritin-iron concentration was also determined and a CVduplo of 11% was found. The ferritin iron concentration increased with an increasing total iron content until saturation of ferritin appeared to be reached at about 3 g ferritin per kg protein. It was concluded that the quantitative determination of bone marrow iron can be of value in the diagnosis and investigation of both hypo- and hyper-ferraemic disorders.

Bone Marrow↗
PubMed1991

Measurements of serum ferritin used to predict concentrations of iron in bone marrow in anemia of chronic disease.

We determined serum ferritin, C-reactive protein (CRP), fibrinogen, and the erythrocyte sedimentation rate (ESR) in 73 patients with anemia of chronic disease. Nomograms of CRP, ESR, or fibrinogen vs ferritin concentrations were constructed and used to estimate the iron store in bone marrow. Iron stores estimated from the nomograms were compared with the results of staining cytological bone marrow smears for iron, the reference method for evaluating iron in bone marrow. In contrast to the results of Witte et al. (Clin Chem 1985;31:1011; Am J Clin Pathol 1986;85:202-6 and 1988;90:85-7), we observed that nomograms of CRP, fibrinogen, or ESR (i.e., acute-phase reactants not influenced by changes in iron metabolism) vs ferritin are not suitable to correct for the acute-phase component of changes in ferritin concentrations. For ferritin concentrations less than 70 micrograms/L, we found that iron deficiency, as judged from bone marrow iron stain, apparently was always present.

Anemia, Hypochromic↗