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R Braakman

Publications and source records attributed to R Braakman.

At least 19 recordsLinked to original sources
PubMed2001

Intensive care management of head-injured patients in Europe: a survey from the European brain injury consortium.

OBJECTIVES: (a) to describe current practice in the monitoring and treatment of moderate and severe head injuries in Europe; (b) to report on intracranial pressure and cerebral perfusion pressure monitoring, occurrence of measured and reported intracranial hypertension, and complications related to this monitoring; (c) to investigate the relationship between the severity of injury, the frequency of monitoring and management, and outcome. METHODS: A three-page questionnaire comprising 60 items of information has been compiled by 67 centres in 12 European countries. Information was collected prospectively regarding all severe and moderate head injuries in adults (> 16 years) admitted to neurosurgery within 24 h of injury. A total of 1005 adult head injury cases were enrolled in the study from 1 February 1995 to 30 April 1995. The Glasgow Outcome Scale was administered at 6 months. RESULTS: Early surgery was performed in 346 cases (35%); arterial pressure was monitored invasively in 631 (68%), ICP in 346 (37%), and jugular bulb saturation in 173 (18%). Artificial ventilation was provided to 736 patients (78%). Intracranial hypertension was noted in 55% of patients in whom ICP was recorded, while it was suspected in only 12% of cases without ICP measurement. There were great differences in the use of ventilation and CPP monitoring among the centres. Mortality at 6 months was 31%. There was an association between an increased frequency of monitoring and intervention and an increased severity of injury; correspondingly, patients who more frequently underwent monitoring and ventilation had a less favourable outcome. CONCLUSIONS: In Europe there are great differences between centres in the frequency of CPP monitoring and ventilatory support applied to head-injured patients. ICP measurement disclosed a high rate of intracranial hypertension, which was not suspected in patients evaluated on a clinical basis alone. ICP monitoring was associated with a low rate of complications. Cases with severe neurological impairment, and with the worse outcome, were treated and monitored more intensively.

Adult↗
PubMed2001

Repinotan (BAY x 3702): a 5HT1A agonist in traumatically brain injured patients.

Repinotan is a high-affinity, selective, full agonist of the 5HT1A-receptor subtype with neuroprotective properties. This paper presents the results of a randomized, double-blind, placebo-controlled study examining the safety and tolerability of three different doses of repinotan in patients with severe traumatic brain injury. Sixty patients were enrolled to receive repinotan (0.5, 1.25, or 2.50 mg/day) or placebo, by continuous i.v. infusion for 7 days. Repinotan treatment had no apparent adverse effects on intracranial pressure, hemodynamic parameters or laboratory parameters. No seizures occurred during treatment, and the incidence and severity of adverse events was as expected for this indication. No serious adverse events were considered related to drug treatment, with the possible exception of one case of inappropriate ADH secretion. No further safety concerns were raised during the 3 months following treatment. On a descriptive basis, the proportion of patients having good outcome or moderate disability (Glasgow Outcome Scale) was somewhat greater in repinotan-treated patients (60%) than in placebo (50%).

Adolescent↗
PubMed1999

The European Brain Injury Consortium survey of head injuries.

To provide a picture of contemporary practice, a survey was carried out of severely and moderately head injured patients admitted to 67 'neuro' centres in 12 European countries. 1,005 adult head injuries were recruited over a three month period. Sixty items of information on demography, clinical features, investigations, management and early complications were captured on a simple, two-page questionnaire and, information on outcome at six months on a third page. The median age of the subjects was 38 years, 74% were male and 51% injured in road traffic accidents; 57% of patients were transferred to the 'neuro' centre from another hospital. Assessment of clinical responsiveness was limited by the use of sedation and intubation and information from four early time points (pre-hospital, arrival at the Accident and Emergency department, post-resuscitation, and arrival at the 'neuro' unit) was combined to stratify the subjects as severe (58%), moderate (17%) or intermediate (19%). In 48% of patients classified the CT scan showed features of a 'mass lesion' and in 40% showed a subarachnoid haemorrhage. Fifty-five centres provided the data on outcome for 94% of the cases recruited in these centres six months after injury. 31% died, 3% were vegetative, 16% severely disabled, 20% moderately disabled and 31% had made a good recovery. Comparison of the data from different parts of Europe showed differences in the frequency of secondary transfer, cause of injury, occurrence of major extracranial injury, CT scan findings, intracranial operation, clinical severity of injury and utilisation of the components of intensive care and the occurrence of a favourable outcome, although the latter difference was not statistically significant when variations in the initial severity of injury were taken into account. The findings in the present survey are compared with newly analysed information for three previous large series: the International Data Bank involving the UK, the Netherlands and the USA, the North American Traumatic Coma Data Bank, and data from four centres in the UK. The comparisons showed substantial similarities and also differences that may reflect variations in policy for admission of the head injury to 'neuro' units, and evolution in methods of assessment, investigation and management. The effects of these differences on outcome requires further, rigorous prospective study.

Adolescent↗
PubMed1999

Effects of topical beta-blockers on the diameter of the isolated porcine short posterior ciliary artery.

PURPOSE: Based on diameter measurements on the short posterior ciliary artery, this study was intended to determine the direct pharmacologic effect of beta-blockers; to determine the differences among a selective beta-blocker betaxolol, a beta-blocker with intrinsic sympathetic activity befunolol, and a nonselective beta-blocker timolol; and to find experimental evidence for the indirect hemodynamic effect of beta-blockers. METHODS: A segment of isolated porcine short posterior ciliary artery was cannulated at both ends and mounted in a pressurized vessel chamber. Vessel diameter was measured as a function of beta-blocker concentration and as a function of change in transmural pressure. RESULTS: In the absence of flow, the mean effective doses (ED50) were 0.8 +/- 0.3 mM, 1.0 +/- 0.3 mM, and 11.6 +/- 6.6 mM (SEM) for betaxolol, befunolol, and timolol, respectively. In the presence of flow, vessel diameter increased with an increase of transmural pressure. The mean relative diameter increased 4.2% +/- 1.0% (SEM) at a transmural pressure step from 30 mm Hg to 60 mm Hg. This increase was not significantly dependent on the presence of any of the beta-blockers. CONCLUSIONS: Only at concentrations far exceeding their expected plasma concentrations, betaxolol, befunolol, and timolol increased the diameter of the isolated porcine short posterior ciliary artery, as a result of their direct pharmacologic effect. Only the difference between the vasodilatory potency of the selective and the nonselective beta-blocker was significant: ED50 of betaxolol was 15 times smaller than ED50 of timolol. There was a positive correlation between the diameter of the isolated porcine short posterior artery (when used as a model for an intraocular artery) and the transmural pressure, which corroborates the indirect hemodynamic effect of beta-blockers. It is speculated that instillation of topical beta-blockers into the conjunctival sac may increase the perfusion of the optic nerve head by an indirect hemodynamic mechanism, but not by a direct pharmacologic mechanism.

Adrenergic beta-Antagonists↗
PubMed1998

Spontaneous remodeling of the spinal canal after conservative management of thoracolumbar burst fractures.

STUDY DESIGN: Forty-two conservatively treated patients with a burst fracture of the thoracic, thoracolumbar, or lumbar spine with more than 25% stenosis of the spinal canal were reviewed more than 1 year after injury to investigate spontaneous remodeling of the spinal canal. OBJECTIVES: To investigate the natural development of the changes in the spinal canal after thoracolumbar burst fractures. SUMMARY OF THE BACKGROUND DATA: Surgical removal of bony fragments from the spinal canal may restore the shape of the spinal canal after burst fractures. However, it was reported that restoration of the spinal canal does not affect the extent of neurologic recovery. METHODS: Using computerized tomography, the authors compared the least sagittal diameter of the spinal canal at the time of injury with the least sagittal diameter at the follow-up examination. RESULTS: Remodeling and reconstitution of the spinal canal takes place within the first 12 months after injury. The mean percentage of the sagittal diameter of the spinal canal was 50% of the normal diameter (50% stenosis) at the time of the fracture and 75% of the normal diameter (25% stenosis) at the follow-up examination. The correlation was positive between the increase in the sagittal diameter of the spinal canal and the initial percentage stenosis. There was a negative correlation between the increase in the sagittal diameter of the spinal canal and age at time of injury. Remodeling of the spinal canal was not influenced by the presence of a neurologic deficit. CONCLUSION: Conservative management of thoracolumbar burst fractures is followed by a marked degree of spontaneous redevelopment of the deformed spinal canal. Therefore, this study provides a new argument in favor of the conservative management of thoracolumbar burst fractures.

Adolescent↗
PubMed1997

EBIC-guidelines for management of severe head injury in adults. European Brain Injury Consortium.

Guidelines for the management of severe head injury in adults as evolved by the European Brain Injury Consortium are presented and discussed. The importance of preventing and treating secondary insults is emphasized and the principles on which treatment is based are reviewed. Guidelines presented are of a pragmatic nature, based on consensus and expert opinion, covering the treatment from accident site to intensive care unit. Specific aspects pertaining to the conduct of clinical trials in head injury are highlighted. The adopted approach is further discussed in relation to other approaches to the development of guidelines, such as evidence based analysis.

Adult↗
PubMed1996

Anterior cervical discectomy with or without fusion with acrylate. A randomized trial.

STUDY DESIGN: A prospective randomized trial with assessment of treatment results by an independent observer and by patient questionnaire. OBJECTIVES: This study evaluated whether implantation of polymethylmethacrylate after anterior cervical discectomy improved clinical results and whether polymethylmethacrylate provided a solid bony union with preservation of anatomical relations of the cervical spine. SUMMARY OF BACKGROUND DATA: Discectomy without fusion disturbs anatomical relations of the cervical spine. Use of an autologous bone graft frequently causes donor-site complications. Therefore, synthetic materials such as polymethylmethacrylate have been used instead of bone to obtain spinal fusion. Whether these implants improve the clinical results of anterior discectomy is unknown. In addition, the radiological follow-up of discectomy with polymethylmethacrylate has hardly been investigated. METHODS: Between April, 1986, and April, 1990, all patients with radiologically proven cervical disc pathology and a radicular syndrome were eligible for this study. The primary endpoint of the study was the clinical result after 2 years. Assessment of the result was rated both by an independent observer using Odom's criteria and by the patient using a written questionnaire. Before surgery and during follow-up, radiographs were obtained. RESULTS: Two patients died during follow up. A good result was obtained in 28 of 42 patients (70%) treated with polymethylmethacrylate and in 30 of 39 patients (77%) of patients treated with discectomy only. Pre-operative neck pain subsided earlier if polymethylmethacrylate was used, but the difference was temporary and clinically insignificant. The use of polymethylmethacrylate resulted in a significant lower bony union rate. Polymethylmethacrylate frequently migrated into adjacent vertebrae. CONCLUSIONS: No relevant clinical differences between treatments were found. The radiological results of anterior discectomy with polymethylmethacrylate were inferior to those of discectomy only. Based on these results, the use of polymethylmethacrylate to obtain fusion after anterior discectomy is not recommended.

Acrylates↗
PubMed1996

Traumatic subarachnoid hemorrhage and its treatment with nimodipine. German tSAH Study Group.

A prospective, randomized, double-blind, placebo-controlled study of nimodipine used to treat traumatic subarachnoid hemorrhage (tSAH) was conducted in 21 German neurosurgical centers between January 1994 and April 1995. One hundred twenty-three patients with tSAH appearing on initial computerized tomography (CT) scanning were entered into the study. Requirements for inclusion included age between 16 and 70 and admission into the study within 12 hours after head injury, regardless of the patient's level of consciousness. Eligible patients received either a sequential course of intravenous and oral nimodipine or placebo treatment for 3 weeks. Patients were closely monitored using clinical neurology, computerized tomography, laboratory, and transcranial Doppler ultrasound parameters. Patients treated with nimodipine had a significantly less unfavorable outcome (death, vegetative survival, or severe disability) at 6 months than placebo-treated patients (25% vs. 46%, p = 0.02). The relative reduction in unfavorable outcome in the nimodipine-treated group was even higher (55%, p = 0.002) when only patients who complied with the protocol were considered.

Adult↗
PubMed1995

[Classification of head injuries based on computerized tomography: prognostic value].

A new classification system for head injury based on the findings of computerized tomography was used in a population of 809 head injured patients. The system emphasizes the status of mesencephalic cisterns, the degree of midline shift and the presence or absence of mass lesions, allowing high risk patients to be identified and outcome to be predicted.

Adolescent↗
PubMed1994

Clinical significance of the finding of subarachnoid blood on CT scan after head injury.

The population analysed consisted of 268 out of 819 patients of a European nimodipine multicentre trial on severe head injury, whose first CT scan after injury showed signs of subarachnoid bleeding. The study demonstrated the importance of traumatic subarachnoid haemorrhage (tSAH) per se as a prognostic factor. The outcome of patients with tSAH is significantly worse than that of patients whose first CT does not show subarachnoid blood (noSAH). The outcome was unfavourable (dead, persistent vegetative state, severe disability) in 60% of tSAH patients compared to 30% of noSAH patients (p < 0.001). The difference in mortality was 42% vs. 14% (p < 0.001). The six month follow-up of tSAH patients complying with the study protocol and treated with intravenous nimodipine, 2 mg per hour for 7 days, showed a statistically significant reduction of unfavourable outcome from 66% to 51% (p < 0.05), compared to placebo treated patients.

Adult↗
PubMed1994

Transient ischemic attacks, carotid stenosis, and an incidental intracranial aneurysm. A decision analysis.

Three patients with transient ischemic attacks (TIAs), a stenotic or ulcerating carotid lesion, and an unruptured aneurysm are discussed. Decision analysis is used in comparing treatment strategies for each patient: clipping of the aneurysm, endarterectomy, or both, with or without platelet aggregation inhibitors. Bayesian sensitivity analysis with Monte Carlo simulation is used to estimate 95% confidence limits for the difference in discounted quality-adjusted life expectancy between the treatment strategies. Platelet-inhibiting therapy is indicated for all three patients, despite the increased risk of complications from subarachnoid hemorrhage. Carotid endarterectomy cannot be recommended for any of the three patients. With regard to aneurysm surgery, a toss-up exists in one patient; in another, the aneurysm should be clipped; and in one, the decision depends on the probability that the TIAs originate from the aneurysm. Guidelines for the management of similar patients are given. For patients with TIAs, a moderate carotid stenosis, and an intracranial aneurysm that does not seem to be related to the symptoms, neither clipping of the aneurysm nor endarterectomy can be recommended with confidence; however, when the intracranial aneurysm is just as likely to be the source of the TIAs as not, clipping is recommended up to the age of 70, when the surgical risks are moderately high.

Aged↗
PubMed1993

Surgery for intracranial meningiomas in elderly patients.

Ninety-three patients above 60 years of age underwent craniotomy for intracranial meningioma removal between 1980 and 1990 at the University Hospital Rotterdam. Sixty-four patients were 60-70 years of age, 29 were 70 years or older. Retrospectively, operative mortality, morbidity and outcome on discharge from hospital and at 6 months were assessed and correlated with age, sex, size and location of the tumor and preoperative neurological status. Seven patients (7.5%) had no or only minor symptoms, 68 (73%) had moderate neurological symptoms (able to live at home with some assistance) and 18 patients (19.5%) had severe symptoms and were dependent on assistance. Surgical mortality was 14%; after 6 months 17% of patients had died. Postoperative complications (surgical, medical or neurological) occurred in 41%. Neurological status 6 months after surgery was improved in 35 patients (38%), unchanged in 38 patients (41%) and worsened in 20 patients (21%), 16 of whom had died. Outcome on discharge from hospital and after 6 months correlated significantly with preoperative neurological status. There was no significant correlation with age, sex, size or location of the tumor. Removal of intracranial meningiomas in the elderly is associated with a high morbidity and mortality rate. However, a large number of elderly patients benefit from surgery for intracranial meningiomas, especially those patients with a good neurological preoperative status.

Aged↗
PubMed1992

Early prediction of outcome in severe head injury.

A survey is given of the development and actual state of the prediction of outcome in severe head injury. Thanks to the data collection in some large databanks it has become possible, in a relatively large number of cases, to estimate reliably the chances of survival and the chance of developing an intracranial haematoma base on clinical data and CT obtained during the first 24 hours. Later during the posttraumatic course prediction is possible of the degree of remaining disability in survivors, and the chances of developing epilepsy and neuro-behavioural sequelae. Due to changing management-regimens further data collection in international databanks is necessary.

Activities of Daily Living↗
PubMed1992

Long-term results of transplantations to repair median, ulnar, and radial nerve lesions by a microsurgical interfascicular autogenous cable graft technique.

A comprehensive analysis of 187 patients (78 median, 86 ulnar, and 23 radial nerve lesions) treated by an interfascicular autogenous nerve grafting technique is presented. After a follow-up of at least 18 months good motor recovery was achieved in 72% of median nerve lesions, 77% of ulnar nerve lesions, and 57% of radial nerve lesions. Good functional sensory recovery was found in 36% of median, 45% of ulnar, and 48% of radial nerve lesions. It appears by multivariate analysis that the results obtained generally were better in younger patients, in patients with a shorter preoperative delay, and in cases with a shorter transplant.

Adolescent↗